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Coaching and PT
Prenatal and postnatal fitness
Home
Services
Coaching and PT
Prenatal and postnatal fitness
About
Bookings
Contact
Bookings
Let’s get started
Open the consultation form
CONSULTATION FORM
Personal Details
Name
*
First Name
Last Name
Email
*
Mobile
*
Occupation
Live/work close-by?
Yes
No
Personal and/or family illnesses
Have you or your direct family ever had any of the following:
Diabetes
Heart problems
High/low blood pressure
Stroke
Asthma
Chest pain
Arthritis
Epilepsy
Osteoporosis
High Cholesterol
Other
Smoking
Do you smoke?
Yes
No
Have you ever smoked?
Yes
No
Medications
Do you take any pills, tablets, medicine, or medication? If yes, please describe
Injury Profile
Have you ever injured any of the following areas of your body?
Head
Neck
Back
Torso
Shoulders
Arms
Hands/wrist
Hips
Upper legs
Knees
Lower legs
Ankles/feet
Goals
Which of the following lifestyle, health and fitness goals are important to you?
I want to…
Get fitter
Get stronger
Build muscle
Lose body fat
I want to feel…
More awake
Healthier
More relaxed
More in control
I want to have….
More time
Less stress
More energy
More fun
Goal for the next 12 weeks:
Commitment
How important to you is it that you achieve the goals above?
Not very
Somewhat
Very
Extremely
What areas are you willing to work on to achieve these goals?
Exercise
Nutrition
Stress/mood
Motivation
In your experience which phrase best describes your motivation levels?
I am self motivated
I find exercise easier to stick to if I have a partner
I find exercise easier with regular appointments
I usually experience some problems with staying motivated
I need constant motivation
Support
From the following list, who is supportive of you achieving your goals
Family
Friends
Work colleagues
What are you expecting from your coach?
Exercise preferences
If you are currently exercising:
What activities are you doing? What do you like about them?
If you have previously exercised:
What activities did you do? What did you like about them? Was there anything you didn’t like about them?
For your exercise in the future:
If you have trained with weights before, what exercises did you like?
On average, how hard would you like to exercise?
1-10, 10 being extremely hard
What time of the day would you like to exercise?
Emergency contact details
Name
*
Phone Number
*
Thank you!