Pre-Consultation Form

Please complete the following questionnaire before your consultation

Name

Phone Number

Age

What is your Height (cm)

What is your weight (cm)

1. What’s your occupation?

2. How much do you move at work?

3. Do you have any medical issues?

4. Do you have any current / past injuries?

5. Have you had a health check-up / assessment recently?

Training and non exercise activity

6. Steps per day / willing to track?

7. Do you currently partake in any form of exercise? If so, what?

8. Are you a member of another gym? Which one? How often?

9. Exercises you like / dislike

10. Realistic sessions per week (in & out of gym)

Nutrition

11. Do you track what you eat?

12. If no, would you be willing to do so?

13. Average daily calorie intake (estimate)

14. Have you dieted in the past? Was it successful?

15. Why do you think this was the case?

16. Do you take any supplements?

17. Dietary requirements

18. How would you describe your eating habits?

Lifestyle & General

19. Do you smoke? If yes, how many per day?

20. Do you drink? If so, how many per week?

21. Does stress play a major part in your life?

22. How healthy do you feel out of 10?

23. How would you rate your quality of sleep?

24. How many hours of sleep per night?

25. Able to give health/lifestyle attention?

26. Digestion or headaches/migraines regularly?

27. Are you Menopause or Pre-menopause?

28. Do you typically breathe through the mouth or nose?

29. When you breathe is it shallow and deep, or light and quick?

30. Have you been diagnosed with ADHD / Autism?

31. Do you suffer from any mental health conditions?

32. Typical Monday food diary (24h)

33. Typical Saturday food diary (24h)

34. Do you have access to a smartphone for our programming?

Your current health markers (Don’t worry if these haven’t yet been tested)

35. Resting heart rate

36. Blood pressure

37. Cholesterol

38. HbA1c

39. Heart Rate Variability

Your Goals

40. What do you want to achieve in the 12 week transformation?

41. Long term goals (1–2 years)

42. Particular outcome goal

43. What are you looking to get out of us as coaches?

44. Had a PT/Coach before? What was the experience like?

45. We like to work with our clients’ personality type and behaviour. Do you like to achieve goals quickly or go slow and steady? (No right answer)

Final Part

46. Preferred training days & times

47. Where did you find out about us?

48. Any additional comments / queries

I consent to being contacted about my enquiry.

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