Clone of Reece Trott Personal Training Pre-Consultation Form

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Instagram handle/username* This field is required.If you don't have instagram, please enter your facbook profile name instead

4

Phone Number* This field is required.

Please enter a valid phone number.

5

Age* This field is required.

Date

6

When's your birthday?* This field is required.DD/MM/YYYY

7

Where did you hear about the BECOME Giveaway?* This field is required.

Instagram

Facebook

TikTok

Referred by a friend or family member

Other

8

In your own words, what are the 3 biggest challenges you have to losing weight right now?* This field is required.For example, staying consistent when thhe kids are off school, knowing what meals to plan, etc

9

Which of the following do you feel needs the most work right now?* This field is required.

Staying consistent with my food & workouts

Making the right choices with my Nutrition

Knowledge / Understanding of food & weight management

Staying accountable to myself

Cultivating a positive, growth mindset

Other

10

What are you most looking forward to receiving from the giveaway* This field is required.

Losing my next stone in weight

Pushing out of my comfort zone

Feeling like i'm in control of my results

Not having to worry so much about my food, weight, or look (confidence)

The ability to be kind to myself while maintaining firm boundaries

Knowledge about how to maintain my weight

A steady consistency

Other

12

In what ways have you tried to lose weight in the past? (tick all that apply)* This field is required.

Support Groups

Restrictive diets (keto etc)

GLP-1's (Mounjaro, Ozempic, Weygovy, etc)

Previous Personal Trainer(s)

Increasing the number of times I exercise

Online Workout Plans/Videos

Increasing my daily movement

None of the above

Other

13

What would it mean for you to win the Become Giveaway?* This field is required.