Consultation Form Consultation Form Full Name * Mobile Number * Address * Address Address Address City City County County Postcode Postcode Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email Address * What do you currently do for a living and what is your activity level like daily? (e.g seated all day, light activity such as walking or heavy labour) * If you are currently working, what is your working week like? E.g same hours each work, shift work etc? * How much 'me-time' do you set aside for yourself weekly, if any? * Do you currently have a morning and evening routine that you follow? * What is currently your average daily screen time? * Give me an insight below into how much sleep you are currently getting and how rested you feel upon waking up. Also what is your bedtime and what is your getting up time? * Are you currently exercising/moving each week? Also, please list any physical activities that you participate in outside of the gym and outside of work. * If you have any diagnosed health problems please list the condition(s). * If you are on any medications, please list them. * If you have any injuries please list them (be specific). * Are you a current smoker? If so how many per day? * Could go give me an insight to your relationship with alcohol? If applicable, a rough insight to how regular you drink and how you feel it impacts your week? If not, leave blank. * How many caffeinated drinks do you consume on a daily basis? And what time is the latest you have one? * What do you think could be the biggest setback or barrier to overcome during your coaching? * If this setback or barrier above was to occur, what impact could that have on your progress and success? * What is the ONE area you feel you need to focus on or establish first? * What is ONE thing you feel you need held most accountable to by your coach? * What gym will you be training at? If restricted to home workouts, please note down any equipment you have including the weight of it. * What have you tried in the past to achieve your training and nutrition goals? Types of diet? Exercise protocols? Previous coaching? Please provide estimated dates. * What are your main goals? And why don't you feel like you've achieved your goals to date? * What are your personal health and fitness goals over the next 3, 6 and 12 months? (Please be as specific as possible.) * Submit If you are human, leave this field blank.