Surveypoint

Q1

Name*

First Name

Q2

Name*

Last Name

Q3

Email*

Q4

Phone Number*

Area Code

Q5

Phone Number*

Phone Number

Q6

Please list your height (in cm's), weight (kg's) and body fat percentage (if known)

Q7

Please list any muscular or joint injuries, aches, limitations or pains.*

Q8

What are your strongest lifts in those movements?

Q9

List your goals and give a brief description of what they mean to you

Q10

When would you like to achieve your results by?

Q11

Please rate on the scale truthfully (1=Poor to 10=Excellent)

1

2

3

4

5

6

7

8

9

10

Overall energy levels

Overall stress

Mood

Anxiety

Strength/fitness

Q12

How many hours of sleep on average do you get per night

Q13

What are the main contributors to your overall stress?

Q14

What is your occupation? What are the demands of your role physically and mentally?

Q15

How much time and what activities do you do to relax?

Q16

What is the time frame between your last meal and your bed time?

Q17

Do you eat breakfast within 30-60 mins upon waking?

Q18

Do you have any food allergies or intolerance's?

Q19

Select the preferences that apply

Tried it

Currently doing

No, open to trying

No interest in trying

Dont know

Meat 3 veg

Paleo

Vegetarian

Vegan

High Protein

Macros

Clean Eating

Fasting

Portion Control

Q20

Diet Snapshot

Q21

Do you:

Yes

No

Drink Coffee Daily

Use Pre-workout more than 1 x per week

Drink alcohol more than once a week

Smoke ciggarettes

Drink 3L water per day

Drink soft drink regularly

Q22

Do you suffer from:

Yes

No

Joint Pain

Digestive Issues

Lethargy

Bloating

Bad Menstrual Periods

Q23

Please answer the following truthfully

Confident

Somewhat Confident

Not Confident

Im prepared to track my food intake

Im prepared to fill in my training plan

Im prepared to send progress pictures as specified

Im prepared to fill in my tracking sheet

Im prepared to modify my diet

Im prepared to take supplements as necessary

Im prepared to modify my lifestyle habits

Q24

Personal Training -Form Fill

Name*

Name*

Email*

Phone Number*

Phone Number*

Please list your height (in cm's), weight (kg's) and body fat percentage (if known)

Please list any muscular or joint injuries, aches, limitations or pains.*

What are your strongest lifts in those movements?

List your goals and give a brief description of what they mean to you

When would you like to achieve your results by?

Please rate on the scale truthfully (1=Poor to 10=Excellent)

How many hours of sleep on average do you get per night

What are the main contributors to your overall stress?

What is your occupation? What are the demands of your role physically and mentally?

How much time and what activities do you do to relax?

What is the time frame between your last meal and your bed time?

Do you eat breakfast within 30-60 mins upon waking?

Do you have any food allergies or intolerance's?

Select the preferences that apply

Diet Snapshot

Do you:

Do you suffer from:

Please answer the following truthfully

Signature Required