New Client Consultation

Name *

First

Last

What name do you prefer to use? Do you shorten your name or use a nickname? *

N/A if not applicable

Email Address *

Mobile Number *

Date of birth *

Have you had a personal trainer or been a member of a gym before? Please specify which *

If yes, how long ago?

What type of training / exercise have you done in the past? If classes please specify what type. *

What exercise do you like, dislike and why? *

Have you previously tried any diets? *

If yes, what have you tried?

If applicable why have they failed? *

Which diets have you found have worked for you? *

Would you say you are a yo-yo dieter? *

Do you have any strongly held views in regards to food / nutrition? If so please detail. Are vegan, vegetarian, pescatarian etc? *

On a scale of 1 -10 (10 being extremely active) how active would you say you currently are on an average day?

Selected Value: 1

Do you currently exercise? *

If yes please detail.

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

On a scale of 1-10 (10 being very stressed) how stressed would you say you usually are?

Selected Value: 1

What is your current occupation? *

Briefly describe an average day for you, from morning until bedtime. *

What does your current diet look like, roughly how many calories do you think you eat in a typical day? *

How much water do you drink on a daily basis? *

If you drink alcohol roughly how many units a week (on average) *

Do you smoke? If yes how many per day? *

What do you do to relax? *

Would you say you are introverted or extroverted? *

Would you say you are results driven? *

Are you competitve? *

Do you prefer: *

Just being shown what to do & you get on with it
Being shown what to do and told why

What is currently keeping you from achieving your goal? *

What is your short term goal? *

What is your long term goal? *

What would you like to achieve: Fat loss, Develop muscle tone, Increase muscle size, Improve cardiovascular fitness, Prepare for sporting event, Medical reasons, Just to feel better *

On a scale of 1 -10 (10 being extremely motivated) how motivated are you to reach your goals?

Selected Value: 1

If you need it, do you have support from friends or family to make changes to reach your goals? If yes please detail. *

How much time are you willing to dedicate to personal training a week? *

On a scale of 1 - 10 (10 being the most) how confident are you that you can reach your goals?

Selected Value: 1

What are the biggest hurdles that you perceive you will face in changing your habits / behaviour in order to reach your goals? *

What do you think you can do to overcome them? *

Do you have any big events coming up? i.e wedding, holiday, stag / hen do etc please detail *

At the beginning I will ask you to weigh yourself so we have a starting point, I may also ask you to track your food for a week or 2 - is this ok? *

If you were me looking at your current lifestyle, what would you change? *

What days and times work best for you to train? *

Do you have any injuries or illnesses that I need to be aware of? If yes please detail below (N/A if not) *

Have you been diagnosed with hypermobility? Please give some info if yes. *

What music do you like to listen to when you exercise? Genre / Band etc *

Emergency Contact: Name. Relationship. Contact Details: *

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