Name

Age

Height (cm)

Weight (kg)

Activity Level
Little/No ExerciseLight Exercise (1-2 days per week)Moderate Exercise (3-5 days per week)Very Active (6-7 days per week)Extra Active (very active + physical job)

Main Target
Weight Loss/Fat LossMuscle GainHealthier Lifestyle

Short Term Goal

Long Term Goal

What struggles have you found have held you back to date?

Email

Mobile Number

Tell me about your current training if any?

How many days per week would you like to train?
12345

Home or Gym?
HomeGym

If you home, could you specify what equipment you have available?

Do you have any medical conditions or injuries I should be aware of designing the program?

I submit that to the best of my knowledge I am in a healthy and fit state to undertake a training programme

Give me a rough overview of your current eating patterns? Not only a rough day to day intake of type of foods, but more importantly the rough times that you eat each day, and whether or not you have a consistent eating pattern?

What are some of your biggest struggles? As in late night snacking, binge eating at the weekends, alcohol consumption etc? Again try and give as much detail as possible

Do you consume any drinks containing calories? Coffees, milk, fizzy drinks, fruit juices, alcohol etc, anything outside of water.
YesNo

If so could you please give me as much detail as possible?

Foods in particular that you like to eat?

Foods in particular that you don't like?

Do you take any supplements? If so, which ones? And for what reason?

By clicking this box you have read and agreed to the terms and conditions of this platform which can be found below