Eternally Fit Pre-Consultation

Eternally Fit

Pre-Consultation Questionnaire
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Tell me about your goals. Please be as detailed and specific as you can.*
How long do you think it will take to reach your goal?*

6-12 months1-2 yearsMore than 2 years
On a scale of 1-5 how important are these goals to you?*

1

2

3

4

5

1 is Not Important, 5 is Very Important. I MUST and WANT to do this!
In my experience, great results have only been achieved by people with powerful, emotional and personal reasons to change. It's one thing to make the decision to change and to know you need to change, it's another to have a powerful, personal, and emotional reason WHY you WANT to change. Why are your goals important to you?*
How will you feel if you don't achieve your goals?*
Will you achieve your goals if you keep doing what you are doing?*

YesNo
What has prompted you to reach out to me? Has something happened recently that has made you "snap" and take action?*
What have you tried in the past to succeed (diets, exercise programs, gyms, Personal Trainers, etc.) and how many times have you tried?*
Why do you think you have not succeeded in the past?*
Are these barriers/reasons still a challenge for you?*

YesNo
When was the last time you really did something for yourself?*
I like to work with people for about 12 months as I know through experience (both personal and professional) this is the minimum amount of time people need for any chance at permanent success. Do you feel you are ready to commit to yourself on this kind of level?*

Yes! DefinitelyNot Sure.No. This is not for me at this time.
The support network around you have around you is critical to your success. If you have a partner, do they know about your goals, and if so, do you have their full support with this?*
Tell me about your eating habits (how many meals/snacks per day, what do you have for breakfast, how many drinks per week, etc).*
How are your energy levels during the day?*
How many hours sleep do you normally get?*

Less than 44-56-7More than 7
How many times have you been sick in the last 12 months?*

NIL1-23-45+
Do you currently have a gym membership?*

YesNo
To your knowledge, do you currently have any of the following conditions outlined below? (PLEASE NOTE: I may need to speak with your specialist if I feel it is necessary – please understand this is part of my duty of care).*

Neck problemsUpper back problemsLower back problemsHip problemsShoulder problemsElbow problemsWrist problemsKnee problemsAnkle problemsArthritisHigh blood pressureLow blood pressureHeart problemsDiabetesDizzinessOther chronic conditionNone of the above
Are you taking any medication or supplements at the moment? If so which ones and why?*
You are the most important investment you'll ever make in your life. How much are you willing to invest per week to guarantee to get the body, health and results you want?*

Around $25 per weekBetween $60 and $90 per weekBetween $100 and $120 per week
Why have you reached out to me in particular for help? There are a LOT of trainers out there...why me?*
Lastly, what would you hope to get from working with me if your application is successful?*
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