JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Perno Performance Online Application
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Prefer not to say
Other:
Occupation
*
Your answer
Country of Residency
*
Your answer
Height
*
Your answer
Weight
*
Your answer
Do you have any medical conditions/allergies/injuries?
*
Yes
No
If you answered YES to the question above, what are your medical conditions/allergies/injuries?
Your answer
What is your current activity level on an average daily basis?
*
None (seated most of the day)
Minimal (light walking)
Moderate (active most of the day)
High (quite active and mostly on your feet)
Very high (heavy labour, very active)
What are you looking for in a training program?
*
Reducing pain
Increasing mobility
Rehabilitation (surgery/injury)
Muscle gain
Strength gain
Fat loss
Improve cardiovascular fitness
Improving posture
Improving energy levels
Nutritional guidance
A strict diet
A quick fix
Sustainable results
Support and guidance from like-minded individuals
Accountability
Required
What have you tried in the past? What worked? What didn't?
*
Your answer
How much time and money have you spent trying to achieve your goals? How does that make you feel?
*
Your answer
On a scale of 1-10, what are you energy levels like right now?
*
I cannot wait for my alarm to sound each morning!
1
2
3
4
5
6
7
8
9
10
Just one more snooze!
Please briefly describe your short-term goals for the next 6-8 weeks.
*
Your answer
Do you have a gym membership?
*
Yes
No
Other:
If you answered YES to the question above, what is the name of the gym?
Your answer
How do you feel about your body, strength, and capabilities right now?
*
Your answer
How did you hear about Perno Performance?
*
Your answer
Why do you want me to be your coach?
*
Your answer
Which of the following describes you best?
*
I'm after a quick fix, a magic pill to get me to where I want.
I'm a procrastinator and am always putting things off.
I'm an action taker and really want to make positive changes in my life.
How many hours a week can you commit to your goals?
*
Choose
< 1
1 - 3
3 - 5
5 +
What are some of your hobbies (at least 1-3)?
*
Your answer
What's your favourite book?
*
Your answer
What's your favourite movie?
*
Your answer
What Training Plan are you after?
*
Basic (1-Day Monthly Program + Perks)
Pro (2-Day Monthly Program, Stretch & Mobility Drills, Perks)
Premium (3-Day Monthly Program, 1-on-1 Zoom, Perks)
Do you have anything else you'd like to add?
Your answer
If you have filled this form out as honestly as you can, please sign with your full name and date below.
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
