Pre-Consultation Form
Full Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
01/01/1986
What are your goals?
How long have you been wanting to achieve these goals?
>6 months
6-12 months
1-2 years
3+ years
On a scale of 1-10 how important for you is it to make these changes?
Have you ever set your own goals before? If so, what were they?
Did you achieve them?
Yes
No
When working towards your goals what were the main barriers you had to overcome?
Time
Knowledge
How to apply the knowledge
Motivation
Unsustainable process
Social/work lifestyle
Other
How would you rate your current activity levels?
Sedentary (minimal movement, desk job, little exercise)
Lightly active (light exercise 1-3 times a week e.g. walking)
Moderately active (daily walks and active exercise 3-5 per week)
Very active (highly active with walks/daily activity, exercise 5-7 times per week)
Which best describes your current nutrition habits?
Poor all the time
More bad than good
Decent through the week, poor at the weekends
Pretty good but not getting the desired results
Perfect, under calories and macros
Other
What's your present gym experience?
Use pin weighed machines
Use free weights
Use cardio equipment
Do classes
Daily walks
Home workouts
Other
When it comes to the gym and exercise, what do you enjoy to do?
In the gym what do you dislike?
When it comes to trying to achieve your goals, what do you feel you need support with the most?
Accountability
Structure
Education
Motivation
Staying consistent
Other
In your own words, what are the main outcomes you would like to achieve from having personal training?
Do you want to add anything else you feel would benefit my understanding of you and what you want to achieve?
Submit
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