Custom Training Information & Confirmation page

Name *

First

Last

Email *

Please check this is correct

Phone *

Date of Birth *

Age *

Height (cm) *

Current Weight (kg) *

Is this your first time working with us? *

Yes
No

How did you find out about this program? *

A referral by friend or family member
Social media
Other

EXERCISE

Experience level *

Just Starting Now
Moderate - have follow a program before
Advanced

What do you hope to achieve from this program? *

Fat loss
Muscle gain
Overall health and fitness

You can only select ONE option as this will determine how we develop your training plans (you can elaborate below)

What are your short term training goals? *

What are your long term training goals? *

Please tell me about your past training experience? *

Injuries that may affect training plans? *

EXERCISE PRESCRIPTION

Do you currently undergo any type of fitness training? If so how often? (Choose one) *

I currently don’t train
Yes I train 1-2x per week
Yes I train 3-5x per week
Yes I train 6+ x per week

What is your current daily activity levels? Choose One: *

Sedentary (Office job) Less than 5000 steps per day
Moderately Active (Teacher, retails etc 5000-8000 Steps per day )
Active (Hospitality, manual labour etc 8000-10000 steps per day.
Very Active 12000 + Steps per day

What type of training are you currently doing and how often/long ? (Be specific EG- Running 2x 30 mins, Yoga 1x , Weights 3x) *

How many days per week do you want us to prescribe weight training ? *

How long can you allow for these weights sessions? *

Do you want a home training plan or gym training plan? *

Home training plan
Gym training plan

If you are wanting a home training plan please list equipment in detail below. *

Write N/A if this is not applicable

Do you have specific areas you would like to work more on? *

Do you feel faint or dizzy when exercising? *

Are you on any prescribed medications? Please list them below *

Nutrition

Have you followed a nutrition plan before? If so please list your dieting history, nutritionist and if this was successful for you? *

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Lastly if you would like to send pics front side and back along with this info it may help me more with how I will prescribe the exercise. Please see PDF Attachments in introduction email on how to take your progress pictures.

Custom Training Form / Confirmation.

EXERCISE

EXERCISE PRESCRIPTION

Nutrition