New Client Consultation Please enable JavaScript in your browser to complete this form.Name *FirstLastPreferred name/nicknameN/A if not applicableEmail Address *Mobile Number *Date of birth *Emergency contact (name, relationship, phone number) *Have you had a personal trainer or been a member of a gym before? Please specify which *Please SelectNoYes - GymYes - PTYes - BothIf yes, how long ago?What types of exercise have you done in the past? *Are there any forms of exercise you enjoy, dislike, or avoid? *Do you currently exercise?Please SelectYesNoIf yes, what do you currently do and how often?What is your current occupation? *Briefly describe an average day for you, from waking up to bedtime. *Roughly how many steps do you do per day? *On a scale of 1-10 ( 10 being the best) how well would you say you sleep? Selected Value: 1 How do you usually relax or switch off? *On a scale of 1-10 (10 being very stressed) how stressed would you say you usually are? Selected Value: 1 Would you describe yourself as introverted, extroverted, or somewhere in between? *Please SelectIntrovertedExtrovertedSomewhere in betweenWhat does your current diet look like? *Have you tried any diets or nutrition approaches before? *Do you have any dietary preferences or restrictions? (vegetarian, vegan, pescatarian, etc.) *Approx. daily water intake *Please SelectMaybe a glass or 2 at a push1-2 LitresI drink like a fishIf you drink alcohol roughly how much & how often?Do you smoke? If yes, how much on average?What is your short term goal? *What is your long term goal? *What would you like to achieve? (tick all that apply)Fat LossDevelop Muscle ToneIncrease Muscle SizeImprove Cardiovascular FitnessFeel Better & Have More EnergyPrepare For Sporting EventMedical ReasonsOtherOn a scale of 1 -10 (10 being extremely motivated) how motivated do you feel right now? Selected Value: 1 On a scale of 1 - 10 (10 being the most) how confident are you that you can reach your goals? Selected Value: 1 Would you say you are results driven? *Please SelectYesNoAre you competitve? *Please SelectYesNoWhat do you think are your biggest hurdles when making changes? *What do you think you can do to overcome them? *Do you have support from friends or family if you need it?Do you prefer: *Just being shown what to do & you get on with itBeing shown what to do and told whyWhat music do you like to listen to when you exercise? Genre / Band etc *Are you currently using, or have you recently used, any fat loss medication (e.g. GLP-1 injections)? *--- Select Choice ---Please SelectNoYes in the pastYes currentlyDo you have any current or past injuries, illnesses, or areas of pain I should know about? *Have you ever been diagnosed with hypermobility or told you have particularly flexible joints? *Have you ever had rehab or treatment for an injury?Everyone learns and stays motivated differently. If there’s anything about how your brain works that would help me support you better (e.g. ADHD, autism, dyslexia, anxiety), you’re welcome to share, but only if you want to.Sometimes I’ll suggest tracking your weight, measurements, photos, or food briefly, are you comfortable with this? *Please SelectYesNoHappy to discussI agree to the following GDPR Agreement *Under the data protection act, all the information that you provide, and which is collected from you, will remain secure and confidential, I will not be shared with any other individuals or parties unless requested the appropriate authorities for example the police.NameSubmit
