Contact form
First & Last name :
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Phone:
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Email:
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Best time of day to be contacted:
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7-9 Early morning
9-12 Late morning
12-2 Lunch
2-5 Afternoon
5-7 Evening
What services are you interested in?:
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Face to face Personal training
Customised online coaching
both
What are your short term fitness goals? (3-6 months):
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What are your long term fitness goals? (1 year +):
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Tick what applies to you:
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I want to feel better
I want to get stronger
I want to lose weight
I want to fix an injury
I want to improve my fitness
I want to build muscle
I have a specific performance related goal
Can you identify any barriers that stopped you from achieving your goals in the past?:
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What do you struggle with the most :
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Gym / Exercise
Diet
All
accountability
Do you have a gym membership / Can you make it to the gym:
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Yes
No
How active are you? (go into as much detail as you can. e.g. sedentary job but gym 5x a week):
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How long have you been training for? And how confident are you using the gym equipment?:
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How long have you been exercising consistently for?:
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My coaching service is a minimum of 8 weeks, are you willing to commit and create some life changing habits/ goals in this time frame? :
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Yes Take me on
Im not sure
How did you hear about me:
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I am a member of puregym leeds city south
word of mouth
social media
other
Is there anything else you'd like to add?:
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