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Pre Consultation Form
Some questions to understand more about your current fitness status
Please email/DM/text me when you submit this form so I can check it out for you
https://movewithmona.co.uk/contact/
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Mobile Number
*
Your answer
Occupation
*
Your answer
City/Town of residence
*
Your answer
How did you find "Move! With Mona"?
*
PureGym App/Website
Gym Floor
Google search
Instagram
Facebook
Referral
Networking event
Other:
How long have you been wanting to make changes to your lifestyle?
*
6 months
1-2 years
2-3 years
5+ years
Other:
How ready are you to make the changes?
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Not ready
Unsure
Ready
Definitely ready
How important is it for you to make these changes and why?
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Your answer
Have you ever set your own goals before and if so, what were they?
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Your answer
Did you achieve them?
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Yes
No
Some results
When working towards your goals what were the main barriers you had to try to overcome?
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Time?
Knowledge?
How to apply the knowledge?
Motivation?
Unsustainable process?
Social life / work lifestyle?
Family?
Other:
Required
How would you rate your current activity levels?
*
Sedentary – (Little to no daily walks, desk job little to no exercise)
Lightly active (Lightly active plus exercise 1-3 times per week)
Moderately active (Moderate daily walks/activity plus exercise 3-5 times per week)
Very Active (Highly active with walks/daily activity and exercise 5-7 times per week)
How would you rate/describe your current nutrition?
*
Terrible all of the time
Not great really more bad than good
Not too bad decent through the week but go mad at weekends
I’m pretty good most of the time but don’t see many results from that
All over it, understand calories know what and how much to eat
What is your present gym experience?
*
Use fixed pin weight machines
Use free weights
Use cardio kit
Use classes
None
Other:
Required
When it comes to the gym, exercise and movement, what do you enjoy to do?
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Your answer
When it comes to trying to achieve your goal, what do you fee like you need support with most?
*
Accountability - Constant confirmation you're doing the right thing
Structure - What to do and when to do it
Education - Knowing why and how to apply the principles into your life
Motivation - Have someone to support you through the process
Staying consistent - Support to overcome barriers
Other:
Required
How long would you say it would expect to achieve that?
*
6 months
1-2 years
2-3 years
5+ years
Other:
In terms of your availability, how many times a week can you train with a personal trainer?
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Once a week
Twice a week
Thrice a week
What times and days in a week can you come to the gym and do personal training sessions? (Example: I work 9-5 so I can do with early mornings or evenings weekdays and/or Sunday)
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Your answer
In your words, What are the main outcomes you would like to achieve from having personal training?
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Your answer
From 1-10 (1 being the lowest and 10 the highest), how committed are you to comply with the fitness programme Mona will set for you in order to achieve your goals?
*
Lowest
1
2
3
4
5
6
7
8
9
10
Highest
Do you want to add anything else you feel would benefit my understanding of you and what you want to achieve?
*
Your answer
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