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Initial Consultation
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Email
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Your email
Personal Details
Name
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Your answer
Full Address
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Your answer
Contact Number
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Your answer
Date Of Birth
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MM
/
DD
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YYYY
Lifestyle
How much sleep do you get each night?
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Your answer
Occupation
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Your answer
Describe your activity level during work?
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Choose
Sedentary
Active
Physically Demanding
Does your job require a lot of travel?
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Yes
No
How many hours do you spending sitting?
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Your answer
Rate your stress levels generally? Enter 1 = Low stress / 10 = High Stress
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Low Stress
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10
High Stress
3 biggest sources of stress i.e. Work, Lifestyle or Lack of sleep
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Your answer
What would you rate your current body shape? Enter 1=Not Ideal / 10 = Ideal?
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Not Ideal
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10
Ideal
What would you like your body to be? Enter 1= Not Ideal / 10 = Ideal
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Not Ideal
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10
Ideal
Fitness
When were you at your fittest?
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Your answer
When were you last exercising regularly?
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Your answer
What stopped you from getting fit in the past?
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Your answer
Where would you rate your current fitness level? Enter 1 = Low Fitness / 10 = High Fitness*
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Low Fitness
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10
High Fitness
Where would you like your fitness to be?
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Low Fitness
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High Fitness
Nutrition
Do you always eat breakfast?
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Yes
No
Do you ever skip meals?
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Yes
No
If Yes, Do you feel normal or dizzy?
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Normal
Dizzy/Faint
Do you eat late at night?
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Yes
No
How many glasses of water do you drink each day?
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Your answer
Do your energy levels drop during the day?
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Yes
No
Can you estimate how many calories you're taking in currently?
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Your answer
How many times a week do you eat out?
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Your answer
Do you have any allergies to foods?
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Such as gluten, or any symptoms of bloating or lethargy
Your answer
Personal Training
Have you had personal training before?
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Yes
No
If Yes, What were you training for? What exercises were you doing with your previous trainer? Did you get results?
Your answer
List 3 goals you'd like to achieve with your trainers help?
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Your answer
When would you like to achieve these goals?
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what's happening at this time? wedding, event, holiday
Your answer
How motivated are you to achieving these goals? Enter 1=Not Very / 10=Very
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Low motivation
1
2
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7
8
9
10
High motivation
Additional Notes
Your answer
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