Ayren Honey Fitness - Top Fitness Trainer in Edinburgh | Get Fit Today

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Ayren Honey on Angled Leg Press

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PERSONAL TRAINING CONSULTATION FORM
PLEASE ANSWER ALL QUESTIONS AS FULLY AS POSSIBLE

This form will give me the best idea possible of what you are looking for from our taster and any further sessions and also allows you the chance to tell me what you need. It also covers all statutory requirements of me by law and complies fully with GDPR guidelines.
Your Data will be kept securely and not used for any other purpose and will be disposed of securely on request as long as it is no longer required for your client account.

*First name

*Last name

*Email

*Phone

Multi-line address

*Country/Region

*Address

*City

*Zip / Postal code

*Birthday

Day

Month

Year

*FT / PT - Occupation

*Emergency Contact Name and Number

*Any Injuries in the past 6 months

YES

NO

Details of Injuries

*Do you or any of your family have a history of any of the following? (click all that apply)

Heart Disease

Diabetes

Other Hereditary Condition

None Known

If you are on any current medication please list it here (names only)

*Do you or have you ever smoked?

*How much sleep on average do you get a night?

If you currently take any supplements please list them here

On a scale of 1 to 5 please rate your consumption of the following. (click 1 each)

*PROCESSED FROZEN FOODS eg Ready Meals

1

2

3

4

5

*PROCESSED CHILLED FOODS eg Pizza, microwave meals etc

1

2

3

4

5

*TAKEAWAY FOODS

1

2

3

4

5

*ALCOHOL

1

2

3

4

5

*SNACKS INCLUDING CHOCOLATE

1

2

3

4

5

*WHOLEGRAIN FOODS

1

2

3

4

5

*WHOLEGRAIN FOODS

1

2

3

4

5

*SALT

1

2

3

4

5

*PROTEIN

1

2

3

4

5

*FRUIT AND VEGETABLES

1

2

3

4

5

*and on a Scale of 1 to 10 WATER

1

2

3

4

5

6

7

8

9

10

If you regulaly skip / miss meals how many of each would you miss in a week? (click your average)

BREAKFAST

I don't skip

1

2

3

4

5

6

7

LUNCH

I don't skip

1

2

3

4

5

6

7

DINNER

I don't skip

1

2

3

4

5

6

7

*Where are you at with your fitness right now - don't overthink this (tick one)

I have no intention of making changes in the next 6 months

I intend to make a change in the next 6 months

I intend to take action in the next month and have already taken some steps toward change

I have already started to make changes

I have already made a change and kept to it for more than 6 months

I have made change but have fallen back to my previous state

If you currently do any form of exercise or fitness activity, what are you doing at the moment?

*How many hours per week do you spend in front of a screen for any reason either work or leisure?

*What has stopped you reaching your goals up till now?

*List your top 3 reasons for wanting a Personal Trainer

*What are your main goals Fitness related or otherwise. Include any information you feel will help.

*Will you be paying your own fees?

YES

NO

If not please provide contact details for the person who will - Name; Contact Number; Email Address

THANK YOU FOR TAKING THE TIME TO FILL IN THIS FORM. I LOOK FORWARD TO HAVING THE OPPORTUNITY TO DISCUSS YOUR TRAINING WITH YOU.

1-2-1 - COACHING - 2-2-1 1 COACHING - NUTRITIONAL ADVICE - BOXERCISE -WEIGHT LOSS - MOBILITY - STRENGTH - MUSCLE GAIN - CARDIO FITNESS - CLASSES

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