ONLINE COACHING INQUIRY
By Iluka Fitness
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What is your Full Name? *
What is your Date of Birth? *
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What is your Gender? *
What City / State / Country are you located in? *
Best Contact number: *
Email address *
What is your Occupation? *
What is your Date of Birth? DD/MM/YYY *
What is your main Goal that you would like me to help you with? *
Required
If Weight Loss or Weight Gain is your goal - how many kilograms would you ideally like to lose (or gain)?
 How long are you willing to commit to working towards your goals? *
How many days per week can you commit to a training/exercise routine? (30-60 mins per day) *
What is your Budget for Online Coaching or a Program? *
Required
Do you have any current or past Injuries that could affect your training? Please give details. *
Do you have any current Medical Conditions? Please select or share any relevant details: *
Do you currently take any Medication? If so, please give details:
Do you have any specific dietary requirements? *
Do you have any known Allergies?
Are you willing to take physical measurements including weight, waist & body circumference, & progress photos to keep track of your progress? *
Are you wanting to train from home, from a gym, and/or what equipment do you have access to? *
Required
Would you like any guidance with your Nutrition? Please tick all that apply. *
Required
What is your current exercise routine, if any? How many days per week do you currently exercise and what do you do? *
Describe your Exercise History - what types of sport or exercise have you done in the past, at what level (eg. beginner/intermediate/athlete) and how long for? *
Have you previously had a Personal Trainer (either face to face or online) or completed a fitness/nutrition program before? *
Are there any specific movements, exercises or specific body areas to target that you would specifically like to learn or focus on?
Do you have any other questions, comments or feedback for me:
I UNDERSTAND that any appointments that I book with Cassie/ Iluka Fitness require sufficient notice for cancellation or rescheduling. Any notice within 24 hrs may result in loss of payment and/or inability to rebook.

By agreeing to undertake Personal Training, I am committing to a minimum of 6-12 weeks in order to see results. I am also committing to uphold my part of the agreement, including doing any extra workouts or exercise, following nutrition protocol and doing the best I can outside of sessions, to work towards achieving my goals. A Personal Trainer is here to guide and motivate you, but cannot do the work for you. Therefore no blame can be taken for a lack of results if you have not done the work required. 

Please sign below:
WAIVER: I acknowledge that I participate in this activity at my own risk, and I hold all responsibility for any injury or damage that occurs to myself or my health. I have given full disclosure of any medical conditions or injuries and have clearance from a GP to exercise. I do not hold Iluka Fitness liable for any injury that may occur due to my participation in Personal Training or programming. 
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THANKYOU for completing this questionnaire! Please follow this link to book in your 20-minute Free Consult with me (if you haven't already made a booking or appointment) so we can discuss your goals and see if we are a good fit for each other, and work out a game plan to help you reach your goals!                                                            
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