Online Coaching Enquiry Form
Norton Fitness Physique
Contact & Basics
Full Name
*
First Name
Last Name
Mobile Number
*
-
Area Code
Phone Number
Gender
*
Female
Male
Non-binary
Prefer not to say
Other
Email Address
*
example@example.com
Goals
Lose weight
Build muscle
Improve fitness
Increase endurance
Improve flexibility
Other
Height (cm)
*
Weight (kg)
*
Health
Average hours of sleep per night
*
Trouble getting to sleep
*
Yes
No
High quality sleep
*
Yes
No
Injuries
No
Shoulder
Elbow
Wrist
Back
Lower Back
Abs
Knee
Other
Lifestyle
Occupation
*
Does your job include shifts?
*
Yes
No
Work setting
*
Office
Out and about
Other
Nutrition and supplementation
Favourite foods
What foods would you like incorporated into your plan?
Favourite snacks
Do you currently track your food?
Yes
No
Please provide a 3 day food diary
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of
How many litres of water do you consume per day?
How many servings of vegetables do you have per day?
Trigger foods that could lead to binging / non-compliance risks
How often do you consume alcohol?
Never
Rarely
Frequently
Every week
Do you take any vitamins or supplements?
Yes
No
Please provide details of any vitamins or supplements you take
Do you smoke?
Yes
No
Training availability
Do you use a step tracking device?
*
Yes
No
How much cardio do you currently do per week, if any?
How many times per week can you commit to the gym?
*
Please Select
3
4
5
6
Other
How long can you spend training per day? (minutes)
*
What days, if any, do you usually workout?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
When do you usually workout?
Morning
Before noon
Noon
Afternoon
Evening
Night
Training preferences
Diet preferences
Vegan
Halal
Non-dairy
Vegetarian
Pescatarian
Kosher
Paleo
Keto
Flexitarian
Allergies or intolerances
eggs
nuts
dairy intolerant
gluten intolerant
Pescatarian
Kosher
Paleo
Keto
Flexitarian
Workout preferences
Movements you enjoy or find easy to progress with
Exercises you do not connect well with or struggle doing
Body areas to focus on most
Non-training days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How many days can you work out?
How experienced are you with strength training?
Beginner
Trained for some time
I have trained for more than 2 years and feel confident
Where do you want to workout?
Home
Gym
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