Thank you for making the first step towards feeling more healthy, fit and strong with me as your personal online coach! Please take a couple of minutes to fill in this questionnaire so that I can accurately tailor your programming to suit your fitness goals.

    Type of Program

    Your Sex

    Full Name*

    Your Email*

    Your Height

    Your Age

    Your Weight

    Body Fat (if known)

    Training History

    What’s your motivation and end goal with your physique and health and fitness?
    (i.e. lose weight, bulk up)

    Do you currently exercise (Be specific)?

    Are you currently following a program?

    Do you train am or pm?

    Do you currently have an injuries or illness?

    Your training facilities (ie public gym, home)?

    How many times do you currently train in a day?

    Are you a professional athlete?

    Are you working with a trainer?

    What do you think has set you back from achieving your goals in the past?

    Are you trying to peak for a specific event?

    If so please provide date.

    What would you rate your daily motivation on a scale of 1 – 10?


    Have you dieted before or followed a nutrition plan?

    Are you allergic to any foods?

    Please provide an example of a day with your current diet.

    Is there any foods you dislike?

    Is there any foods you wish to include e.g. favourite healthy foods?

    Are you taking any medications?

    How many meals do you eat per day?

    What’s your biggest area you wish to improve on with your nutrition?

    Any additional comments you wish to include?

    Have you read, understood and agree to the LEGAL DISCLAIMER?
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