Client Questionnaire

Just fill in the details below and click submit, to send your details to one of our Personal Trainers

First Name *

Surname *

Email *

Phone *

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Date of Birth *

Sport / Level / Position (if relevant):

What has motivated you to seek out a Personal Trainer / Strength & Conditioning *

What are your goals? (Rank in order of importance): *

Why are these goals important to you? *

Do you have any specific timelines for achieving your goals? *

How confident are you that you can achieve these goals? (1 Not confident 10 Highly confident) *

Current Lifestyle In terms of your current lifestyle rate your current levels 1-10 on the following key lifestyle factors

Sleep Quality *

10 being the best sleep10987654321

Stress Levels *

10 being the most stressful10987654321

Activity Levels *

10 being the most active1097654321

Meal Frequency *

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Lean Protein Consumption *

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Supplementation Support *

Omega 3, Vit D, Magnesium at bedtime, Multi V, Probiotic (Gut Enzymes)10987654321

Fruit and Veg Consumption *

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Support Systems - Friends and Family *

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Water Consumption *

Litre's per day0.511.522.53More

Medical History / Previous Operations (Muscular-Skeletal) / Medications: *

Previous and Current Injuries (including ‘niggles’): *

Describe Your Previous and Current Training History: *

What facilities and equipment (if any) do you have access to?: *

How much time (realistically) do you want to commit to your Training?: *

State any ‘interferences’ (travel, work-life balance, other training, family, social life etc...): *