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| Name:
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| Age:
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| Gender:
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| Email:
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| Telephone:
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| Which gym are you currently a member?
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| Height:
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| Weight:
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| Build:
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| What are your Primary goals:
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| Examples: Lose Weight / Build Muscle / Improve Fitness...
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| What are your Secondary goals:
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| Examples: To also improve my diet/eating habits...
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| What exercise are you currently doing and how often?
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| Example: I do 30 minutes on the cross trainer, 3 days a week
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| Where abouts are you wanting to train?
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| Examples: Gym? Home? Outdoors? Multipul locations...
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| What days would you be prepared to train / how often?
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| Example: 3-4 times per week, maybe Mon, Wed & Fri...
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| Do you have any medical problems or injuries which may effect your training?
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Do you smoke?
If so, please give a rough estimate of how many how often:
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| Please outline what kind of foods and drinks you consume on a daily basis:
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| Example: Breakfast, scrambled egg on toast, etc...
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| Do you skip any meals, or do you have all 3 main meals per day?
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| Example: Skip breakfast, have lunch, dinner and snacks...
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| How many glasses (250ml) of water do you drink on average per day?
| As per a typical day...
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| Do you drink Tea or Coffee? If so, how much?
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| Please include if you add milk, sugar or sweetners...
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| Do you drink Tea or Coffee? If so, how much?
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| Please include if you add milk, sugar or sweetners...
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| Over the past couple of months how has your weight been?
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| Please include any questions you have?
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| Finally, how did you find out about this website?
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EMF Contact Form
EMF Contact Form