ONLINE CONSULTATION

ONLINE CONSULTATION

Andrew Davies Personal Training & Nutrition
Full name *

First Name Last Name
Email *
example@example.com
Phone Number *

- Area Code Phone Number
Preferred method of contact? *

Email Phone call Text
Date of Birth *
Your current weight? *
Your sex? *

Male Female Other
Your height? *
Job Role? *
Details of your journey to work? *
Work start/finish time? *
How much sleep do you get per day? *
Stress level? *

5 stars - very stressed
Are you currently a member of PureGym Barrow Road Bristol? *

Yes No
How many days per week do you order takeaway? *
How many days per week do you drink alcohol? *
Do you snack or pick at food throughout the day? *
What is your 'go to' comfort food & how often would you eat it in the week? *
How many days per week are you physically active? *
On average what is your daily step count? *
When are you most productive? *

Morning Mid-Morning Afternoon Evening
Please state any injuries within the last 12 months along with any medication you may be using. *
Do you know any reason why you cannot partake in physical activity? *
Do you smoke? *

Yes No Social smoker
Do you have support towards your fitness goals from friends, family etc? *
Please state in as much detail as possible
What do you feel you need from me as a trainer to accomplish your goals? *
What is the biggest obstacle preventing you from achieving your goals? *
What or who inspires you to change? *
What area of fitness are you looking for? *
If other please state below
What has worked well for you in the past and why are you not doing it now? *
In detail what are you hoping to achieve through personal training? *
What is your main area of weakness? This could be food or exercise related. *
What is your commitment to change? *

5 stars - very commited
How motivated are you? *

5 stars - very motivated
Have you ever had a Personal Trainer before? *
If yes, please state all details
How many times per week would you like personal training? *
How much money would you be willing to invest towards your health, lifestyle and fitness goals? *
Do you know someone who may be interested in training with you? *
If yes, please provide details below.
Name of friend

First Name Last Name
Phone Number of friend

- Area Code Phone Number
Email of friend
example@example.com
Please note that all information provided is strictly confidential between Andrew Davies Personal Training & Nutrition and yourself. Your information will not be shared with any other organisation or third party. If you have any concerns please email Andrew Davies direct at - andrewdaviespt@hotmail.com.

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By clicking this button, you submit your information to Andrew Davies Personal Training & Nutrition, who will use it to communicate with you regarding this form and their other services. *

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