Online Programming Application
Thank you for your interest in signing up for online coaching. This questionnaire will take 2-3 minutes to fill out and will help me personalise how I can go about helping you reach your goals on the quickest path possible.

Please take the time to fill it out and I'll be back in touch very soon.

Before we get started it is incredibly important to state my scope of practice in terms of nutrition. I prescribe exercise and give nutritional information in terms of promoting general health and to help change body composition (fat loss, muscle gain). I cannot, and do not, treat medical conditions.

I also cannot help if a person is suffering from an eating disorder.

Symptoms of eating disorders include:

- spending a lot of time worrying about your weight and body shape
- avoiding socialising when you think food will be involved
- eating very little food
- making yourself sick or taking laxatives after you eat
- exercising too much
- having very strict habits or routines around food
- changes in your mood such as being withdrawn, anxious or depressed

You may also notice physical signs, including:

- feeling cold, tired or dizzy
- pains, tingling or numbness in your arms and legs (poor circulation)
- feeling your heart racing, fainting or feeling faint
- problems with your digestion, such as bloating, constipation or diarrhoea
- your weight being very high or very low for someone of your age and height

If you have any of the symptoms listed I recommend you contact your GP so you can get the proper support you need.

By signing up you understand the conditions under which we will work together and the fact that medical treatment is not within my scope of practice.

My coaching programme consists of both an exercise programme and nutritional coaching.

Thanks for taking the time to fill this out :-)

Sign in to Google to save your progress. Learn more
€150 per month, no long term contract, cancel any time.
Name *
Date of birth *
MM
/
DD
/
YYYY
Email address *
Where do you live? (country of origin) *
What is your gender? *
What's your favourite TV series or movie (I'm always looking for something good to watch)?
Do you have any hobbies/interests or favourite things to do? Do you follow any sports teams or have a band you love?
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy