Full Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
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1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Age
*
years
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Height
*
cm
Weight
*
KG
What are the three most important things/aspects to you in your life at this present time?
What are your objectives? What do you honestly want to get out of the program in the next month?
What do you do for a living?
*
Whats the activity level at your job?
*
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
*
Please list the physical activities that you participate in outside of the gym and outside of work.:
*
What other hobbies or activities do you partake on a regular basis?
*
If you have any diagnosed health problems list the condition(s).
*
If you are on any medications, please list them.
*
What additional therapies are being undertaken for the given health problem(s)?
*
If you have any injuries, please list them.
*
What additional therapies are being undertaken for the given injury?
*
Are you experiencing any stresses or motivational problems?
*
Yes
No
Has anyone of your immediate family developed heart disease before the age of 60?
*
Yes
No
Do any diseases run in your family?
*
Yes
No
If yes please list:
Do you suffer from diabetes, asthma, high or low blood pressure?
*
Yes
No
If yes please list:
Are you a current cigarette smoker?
*
Yes
No
Your current diet could be best characterised as:
*
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
Please state your dietary requirements? (eg any foods you can't/will not eat)
*
How many meals per day do you currently eat on average?
*
Do you eat very similar meals each day or are they more varied/erratic: eg. bought packaged goods etc... (please expand)
*
Choose a standard day to record what you eat and drink. This MUST be precise; for example, record the time meals or drinks are consumed, and even the amount of sugar you put into your coffee etc. This must also be a day that will honestly reflect what your typical food/drink consumption is. Please be honest, this is a judgement free zone
Have you tried any diets?
Yes
No
If yes, for each one please let me know your specific reason for doing it and how long you tried/stayed on it. Also, include if there was anything you enjoyed about them or disliked about them.
Please rate your readiness for change.
*
1
2
3
4
5
6
7
8
9
10
What are your goals? (Please number goals in order of importance, 1 being most important)
*
Rows
1
2
3
4
5
Lose body fat
Build muscle
Get stronger
Get fitter
Performance based
Other
Please expand on your goals (Quantifying your targets, expectations, timescales, previous experiences)
*
Timeline for achieving your goal.
*
Rows
8 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
How often are you willing to train a week to reach your goal?
*
Are you training in a gym?
*
Yes
No
If no, would you be willing to train in a gym?
*
Yes
No
Tell me: of any unavailability, sporting commitments, gym access, etc.
*
Do you have access to any equipment at home?
*
Yes
No
If yes, what equipment do you have?
*
What is your current level of activity/fitness level?
*
What exercises/activities you dislike?
*
Please rate your motivational level to do what it takes for reach your goal.
*
1
2
3
4
5
6
7
8
9
10
Are you currently exercising regularly?
*
Yes
No
If yes, how often are you training per week?
*
Have you trained with a personal trainer before?
*
Yes
No
If yes what kind of training did you do:
*
Have you worked with an online coach before?
*
Yes
No
I confirm I am happy to subscribe to emails and communication from Vee Fitness with nutrition tips and workouts.
*
Yes
No
Submit
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