Pre-Consultation Form
Name:
Email:
1) How long have you been wanting to make changes to your lifestyle?
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6 months
1-2years
2-3years
5+years
2) How important is it for you to make these changes and why? (Rating system
1-10, with 1 being least important & 10 being most important)
3) Have you ever set your own goals before and if so, what were they?
4) Did you achieve them?
5) When working towards your goals what were the main barriers you had to try
to overcome? Below mentioned are some examples 
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Time?
Knowledge?
How to apply the knowledge?
Motivation?
Unsustainable process?
Social life / work lifestyle?
Family?
6) How would you rate your current activity levels?
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Sedentary – (Little to no daily walks, desk job little to no exercise)
Lightly active (Lightly active plus exercise 1-3 times per week)
Moderately active (Moderate daily walks/activity plus exercise 3-5 times per
week)
Very Active (Highly active with walks/daily activity and exercise 5-7 times per
week)
7) How would you rate/describe your current nutrition? (Rating 1-5 or multiple
choice)
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Terrible all the time
Not great worse than good
Not too bad decent through the week but go mad at weekends.
I am pretty good most of the time but don’t see many results from that.
All over it, understand calories know what and how much to eat.
8) What is your present gym experience? (Multiple choice)
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Use fixed pin weight machines?
Use free weights?
Use cardio kit?
Use classes?
Daily walks
Home workouts
9) When it comes to the gym, exercise, and movement, what do you enjoy
doing?
10) What do you find you dislike and do not enjoy?
11) When it comes to trying to achieve your goal, what do you fee like you need
support with most?
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Accountability - Constant confirmation you're doing the right thing
Structure - What to do and when to do it
Education - Knowing why and how to apply the principles into your life
Motivation - Have someone to support you through the process
Staying consistent - Support to overcome barriers
Add More?
12) In your words, what are the main outcomes you would like to achieve from
having personal training?
13) How long would you say it would expect to achieve that?
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3 Month
6 months
1-2years
2-3years
5+years
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