Name
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First Name
Last Name
Email
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Contact number
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Date of Birth :
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Height in cm
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Current weight in kg
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What is the reason why you have decided now is the time to get some support with your goals?
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Tell me about your day to day lifestyle.
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What do you do for work? How much of your day are you on your feet? Do you regularly go out to socialise?
Tell me about your current sleep?
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How many hours a night sleep do you get? How would you rate your quality of sleep?
How would you describe your relationship with your body?
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How do you feel about your body? How do you treat it?
Have you ever worked with a coach or a personal trainer before?
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If 'yes' please give details about your experience.
Have you ever followed a diet and/or training plan before?
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This could be anything from a workout plan you downloaded from the internet, slimming world etc.
If 'yes' please tell me what you followed and for how long you followed this, did you achieve what you wanted from it?
Tell me about your current diet.
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Outline a typical day of eating for you (breakfast, lunch, dinner, snacks)
Do you eat out/get takeaways? If so how often?
Tell me about your food likes/dislikes/allergies.
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Please outline any food allergies as well as any foods that you dislike and that you really enjoy having in your day to day diet.
How would you describe your relationship with food?
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Have you ever suffered from any form of disorders eating? Do you rely on tracking as a way to control your intake?
Are you currently taking any supplements?
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If 'yes' please outline what you are currently taking.
(please include any multi-vitamins, whey protein, creatine etc)
Do you drink alcohol?
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If 'yes' how much do you usually drink and how often?
Do you wear/use an activity tracker/smart watch?
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Yes
No
If yes, how many steps per day do you average?
3-5K per day
5-8K per day
8-11K per day
11-15K per day
15k + per day
Tell me about your current exercise.
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What are you currently doing?
Please state any resistance/weight training, cardio, classes etc.
How much time can you commit to exercise?
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Please outline how many times per week you are able to exercise and for what duration.
Tell me about your exercise likes/dislikes.
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Are there certain exercises you connect with more or something that you really don't like doing?
Do you have any injuries or medical conditions that need to be taken into consideration?
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If 'yes' please provide details.
Any other information that you feel is relevant?
Thank you for completing your questionnaire!
I will be in touch shortly to book in your consultation.
In the meantime if you have any questions please do not hesitate to contact me.
I look forward to speaking with you soon.
