Member Information

Full Name(Required)

Age(Required)

Date of Birth(Required)

Email(Required)

Phone Number(Required)

Gender(Required)

Male
Female

Emergency Contact

Full Name(Required)

Relationship(Required)

Telephone Number(Required)

Exercise

Have you ever trained at a gym or under a personal trainer? If so, why did you choose to stop training?(Required)

Do you partake in any recreational activities such as walking the dog or netball? If so what, when and how often?(Required)

Goals

Obviously you have goals that you wish to achieve, what are they?(Required)

WHY is this goal important to you?(Required)

After you’ve achieved your goal, is maintaining your progress important?(Required)

Yes
No

Where do we come into the plan for you, how can we assist you in reaching your goals?(Required)

Motivation
Support
Accountability
Nutritional Guidance
Knowledge
Structure/Planning
Other, if so what?

Other, if so what?

What are your expectations regarding time frame, when do you want to see results?(Required)

Are there any obstacles that have prevented you from reaching your goals in the past?(Required)

Why will these obstacles not be a problem now?(Required)

WHY did you choose that number and not a lower number?(Required)

Nutrition

How many meals would you have per day?(Required)

What best describes your current diet? (Vegan/Vegetarian, Paleo, Keto, Low Carb, High Protein, Low Fat, Anything)(Required)

General Health

What is your current occupation?(Required)

What time do you go to sleep and wake up on an average?(Required)

How much water do you drink a day on average?(Required)

Medical

The following information will be treated as private

What is your current blood pressure?(Required)

Do you have any previous injuries or medical conditions that may affect your ability to safely exercise?(Required)

Yes - If yes, please explain below.
No - If no, write N/A below

Medical conditions details(Required)

Are you currently taking prescribed medication(s) for any condition(s)?(Required)

Yes - If yes, please explain below.
No - If no, write N/A below

Prescribed medication details(Required)

Are you pregnant or have you given birth within the last 12 months?(Required)

Yes - If yes, please explain below.
No - If no, write N/A below

Pregnancy details(Required)

Do you know of any other reason why you should not do physical activity?(Required)

DISCOVERING YOUR WHY

Your answers will only be seen by your COACH which will then be used to be able to support you in the pursuit of your GOALS.

12 months from now what would be your DREAM RESULT?(Required)

WHY are these results IMPORTANT to you?(Required)

WHAT has stopped you from achieving these results in the Past?(Required)

WHY are you not willing to let these obstacles stop you anymore and what have you missed out on from feeling this way in the past?(Required)

WHEN was the last time you really FELT GOOD about your body?(Required)

WHY did you FEEL GOOD then?(Required)

What do you think will happen if you DON'T make the CHANGES needed to achieve your goals?(Required)

What do you think I should do as your COACH if you fall behind in the pursuit of your goals or break our agreements?(Required)

Out of 10, with 10 being absolute commitment, how willing are you to do what it takes to achieve your goals?(Required)

1= "Can I start after the GAME OF THRONES season has finished?" 10 = "BEAST MODE ACTIVATED, I'VE GOT THIS!"

WHY did you NOT choose a lower number?(Required)

What will you CELEBRATE by doing when you achieve this DREAM RESULT? (buy a dress, new clothes, holiday on a beach without a top on etc)(Required)

Test-form