Client Questionnaire
Fill out this questionnaire to see if we'd be a good fit together! This questionnaire helps me establish what your current health levels are, your goals and your lifestyle. If you don't receive an email back within 24 hours, please check your junk email folder!
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Email *
Full Name *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Height *
Weight (specify lb/st/kg) *
What do you do for a living?
What's your activity level at your place of work?
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Do you follow a regular working schedule or work unregular shifts?
How often do you travel?
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Do you currently participate in any physical activity? If so, what activities and how often?
How would you describe your current diet? Do you follow any specific diet or have any special requirements?
In terms of nutrition, what do you struggle with the most?
Rate your readiness for change
Not ready for change
Ready and raring to go
Clear selection
What are your nutrition goals? *
When do you want to achieve these goals by?
Clear selection
Rate your motivation level to do what it takes to reach your goals
Not motivated at all
Extremely motivated
Clear selection
What are your expectations of me, as your Personal Trainer and Online Coach?
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