Eternally Fit Pre-Consultation

Eternally Fit

Pre-Consultation Questionnaire
Wanting to work with me?

That's great. Thank you!

But before you do, I need to get to know you better before we speak so I can get a good idea of who you are, where you've come from, what you've struggled with, and most importantly, what you'd like to achieve.

To ensure you get the most from our conversation, to make sure we're a good fit, and that my program is right for you, please fill out this form.

Give me as much detail as possible! The more detail and honesty you give me, the more I can help you.
Name *

First Name Last Name
E-mail *
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 months 1-2 years More than 2 years

On a scale of 1-10 how important are these goals to you? *

	1	2	3	4	5	6	7	8	9	10

1 is Not Important, 10 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? *

Yes No
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. *
What have been the 2 main barriers/reasons why you have not succeeded in the past? *
Are these barriers/reasons still a challenge for you? *

Yes No
When was the last time you really did something for yourself? *
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? *

Less than $25 per week Between $50 and $90 per week Between $100 and $150 per week
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! Definitely Not 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 4 4-5 6-7 More than 7
How many times have you been sick in the last 12 months? *

NIL 1-2 3-4 5+
Do you currently have a gym membership? *

Yes No
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 problems Upper back problems Lower back problems Hip problems Shoulder problems Elbow problems Wrist problems Knee problems Ankle problems Arthritis High blood pressure Low blood pressure Heart problems Diabetes Dizziness Other chronic condition None of the above
Are you taking any medication or supplements at the moment? If so which ones and why? *
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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Eternally Fit

Wanting to work with me?

That's great. Thank you!