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Fitness & Wellness Consultation
Wellness consists of mind - body - spiritual fitness. These three needs be aligned in harmony for an individual to be well. Please fill the form as accurately as you can so we can help you better.
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Email
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Your email
Are the issues you face urgent? If so what is the best number to call you on?
Your answer
What do you hope to get out of this program?
Lose weight
Build muscles
Get fitter
Get leaner
Preparing for an event
Connect with others.
Develop Abs
Strength Training
Your Name
Your answer
How do you feel today?
Your answer
Are there any issues that you face in any areas of your life that currently cause you stress?
Your answer
How is your general physical fitness?
Very bad
bad
good
Very good
Other:
Clear selection
Your Sex
Male
Female
Prefer not to say
Clear selection
What is your BMI? Check your BMI here:
https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/
Your answer
Your Age
Your answer
How is your general mental health?
Very bad, I get stressed a lot
bad
Ok
good
Very good
Other:
Clear selection
How is your general spiritual health?
I have faith
Not that great
Other:
Clear selection
How is your general financial health?
Very bad, I can't cope
bad but I can cope
Ok
good
Very good
Other:
Clear selection
Do you have any specific request, goals or needs where if met would ease the stress and worry you may currently be facing?
Your answer
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