Initial Consultation - Online Questionnaire

Your email*:

Your name(s)*:

Your contact details*:

What is it you want to achieve?

How will you benefit when you achieve this?

Exercise

Have you been exercising consistently for the past 3 months? Yes/No:

What exercise and fitness activities are you presently involved in?

If your exercise activity levels are lower than you would prefer, what are the reasons?

How would you rate your present fitness levels on a scale of 1 (very low) - 10 (very high):

Which are the best days of the week for you to commit to your exercise programme (please list)?

Which are the best times of day for you to train (please list)?

What do you think is the most important thing your Personal Trainer can do to help you achieve your exercise and fitness goals?

Lifestyle

Do you drink alcohol? Yes/No:

If yes, how many units per week approx?

What, if any, changes are necessary with regard to your alcohol consumption?

How would you rate your stress level on a scale of 1 (very low) - 10 (very high):

Please list your 3 biggest sources of stress:

How many hours do you regularly sleep at night:

Nutrition

How would you rate your present nutrition/eating & drinking habits on a scale of 1 (poor) - 10 (excellent):

Why have you picked this number?

Apart from hunger, for what other reasons might you eat or drink (eg boredom, social, stress, nerves, depressed, happy, anxious)?

In the next few boxes, please take us through a typical day's eating:

Breakfast:

Snacks:

Lunch:

Snacks:

Dinner:

Drinks (non-alcoholic):

How might this differ at the weekend?

Have you ever kept a food diary? Yes/No:

Would you be willing to keep a food/drinks diary? Yes/No:

List 3 areas of your nutrition/eating & drinking habits that you would like to improve:

What, if any, other obstacles or barriers might impede your progress towards achieving your goals?

How can these obstacles be overcome?

Medical

Please list any injuries, strains or medical factors that would affect your ability to exercise:

How did you hear about us:

Why have you shown an interest in training with Fit Shape instead of another organisation or establishment?