Coaching Enquiry Form

Your name

Your email

Your Telephone Number

Your Age:

Your Height in CM:

Your Weight (if known) in KG:

Gender:
MaleFemale

Could you be pregnant (Ladies Only):
YesNoN/A

If Pregnant, Are you Breastfeeding (Ladies Only):
YesNoN/A

Do you currently participate in any physical activity? If yes, what do you do?

How Active is your Occupation?
Sedentary - EG Office Work
Lightly Active - EG Shop Assistant
Active - EG Nurse
Very Active - EG Labourer / Armed Forces

SedentaryLightly ActiveActiveVery Active

Do you have any injury or contraindications that could limit exercises? If yes please state what.

How Many Days could you commit to exercise?

Please list what exercises equipment you have at home and whether or use a Gym.

Please could you briefly explain to me what your main goal is?

Why do you think you haven’t achieved this before? If you have, what happened?

How Many Steps a day are you currently achieving?

Approximately how much water do you drink daily in Litres?

Is there anything else you think I should know?

How would you prefer me to contact you once I receive your enquiry form? Phone call, email or text message?

What would be your ideal start date?

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