Name: *

Surname: *

Phone number: *

Age: *

Height (ft): *

Weight (KG): *

Date Of Birth: *

Home Address & Eircode: *

Do you smoke? If yes, how many daily?: *

Any regular antibiotic/medication? If yes, please specify type and amount: *

Do you suffer from food allergies? If yes, please specify and provide as much detail as possible:: *

Are you currently taking any supplements? if yes, please specify amount and type:: *

Any previous health concerns or injuries? If yes, please specify and provide as much detail as possible:: *

Any specific areas that you feel are stiff/weak? If yes, please specify and provide as much detail as possible:: *

Do you suffer from high/low blood pressure? If yes, please specify and provide as much detail as possible:: *

Any respiratory problems? (Asthma etc) If yes, please specify and provide as much detail as possible:: *

Any chronic long term illnesses? If yes, please specify and provide as much detail as possible:: *

Are you or have you been pregnant in the last 6 months?:: *

Are you currently exercising? If yes, please indicate the type of exercise you are doing, how many times per week, and the duration of your workout:: *

What type of exercise do you like to do?:: *

Do you have any hobbies? If yes, please specify and provide as much detail as possible (e.g. soccer training x2 per week and matches on a Saturday):: *

Do you have good energy throughout the day? :: *

Do you plan on working out in the mornings or the evenings? Are you making it a set routine with a specific time to workout for that day or will it be mixed?:: *

How many times a week would you be willing to dedicate to exercise?:: *

Would you rather a gym workout program or home workout program?: *

If home workout, please attach photos of the equipment you have at home here. It is very important these are uploaded for me to get your program together. I Won't be able to get your program ready until I know so please include this info.:

If Gym Workout program, please name the gym you will be joining. It is very important for me to know this in so I can check online the equipment that gym has in order to put your program together. I Won't be able to get your program ready until I know so please include this info.:

If its a gym program - Are you comfortable using machines etc in the gym or would you feel more comfortable sticking to dumbbell exercises for now until you build your confidence with it?: *

Do you have an Apple Watch/fitbit etc to track steps?: *

Would you like to take the approach of tracking steps or take a different approach?: *

Do you suffer from high levels of stress? If yes, what are the main causes of stress? :: *

What would you rate your level of stress on a daily basis out of 10? (10 being highly stressed) :: *

Do you have any current coping methods? If yes, please specify:: *

Are you currently working at the moment? If yes, please specify your occupation:: *

Do you work night shift/day shifts? Please explain in as much detail as possible:: *

Do you have a sedentary job or are you up on your feet all day?:: *

On average how much sleep do you get a night?:: *

Do you look at screens (tv or phone before going to sleep?:: *

Do you have a sleeping pattern? If yes, please specify sleep time/wake up time:: *

Do you wake up tired or energised for the day ahead?:: *

Do you drink caffeine? If yes, please indicate type, amount and time of final caffeine intake throughout the day.:: *

Do you have a regular or irregular menstrual cycle? Please specify and explain in as much detail as possible:: *

Do you suffer from bloating and/or cravings around this time? Please specify and explain in as much detail as possible:: *

Are you on any contraceptive pill/bar etc? If yes, please specify:: *

What is your goal and what do you want to achieve? :: *

Why do you want to achieve this goal and how important is it to you?:: *

When did you feel at your best and where do you think it went wrong?:: *

Is there anything in particular that you struggle with most or needs a bit more work?:: *

What has stopped you from achieving this goal up to now?:: *

What areas of your goal do you know least about? (e.g do you struggle with nutrition or sleep or anything your really unsure of that you would like me to educate you on) :: *

Do you have any specific occasions/events/holidays coming up? (PLEASE INCLUDE DATES): *

Where would you like to be in 6 months from now? :: *

What does a successful journey with ND Academy look like for you?:: *

Have you tried any Personal training/Online coaching/Nutrition plans before? If yes please specify and provide as much detail as possible:: *

Did they work/not work and if not why? Please explain in as much detail as possible:: *

How is your relationship with the weighing scales? Is this something that may trigger you?:: *

Do you want to track scale weight? Please note if we are tracking scale weight, you will have to weigh yourself a minimum of 3 times weekly first thing fasted across three mornings. The reason for this is because one singular measurement isn't going to show you anything in terms of your progress. I have some clients who want to use it and others who don't use it. You will still make progress however if it would be too much for you to do that each week we best leave it out. Weighing once per week is a waste of time and won't show you anything. We have to track progress in a collection of ways to ensure things are moving in the right direction and the scales alone won't do that. So my advice is we either add it to that collection of tools or we don't use it at all. Checking once a week every so often really is a waste of time. If you make a decision on what you would prefer we can take it from there.: *

How many meals roughly do you eat a day? :: *

Have you ever had a poor relationship with food?:: *

How is your relationship with food now?:: *

Do you have any trigger foods/foods you see as 'bad' or restrict yourself of?:: *

If you are currently tracking calories, How many calories are you eating at the moment?:: *

Have you ever used MyFitness pal or do you know how to use it? :: *

Would you be comfortable tracking food on my fitness pal?:: *

How many litres of water do you drink in a day?:: *

How often do you eat take-aways? :: *

How often do you drink alcohol? How much/type of alcohol do you drink?:: *

Do you pack your own lunch for work? If yes, what would you normally have? If no, what would you normally get?:: *

Do you eat in a hurry? How long on average would you spend eating breakfast/lunch/dinner?:: *

Do you sit at a table to eat your meals or do you eat on the go?:: *

Do you look at your phone/watch t.v whilst eating your meals?:: *

Are you vegan/vegetarian/strong dislikes etc?:

To ensure I have enough time to get you the results you desire, there is a 12 week commitment phase which then leads into a monthly subscription with the option of finishing up with a months notice from thereafter. I could not possibly work off a shorter time frame as usually for what a lot of people want to achieve will need time even more time than that. The 12 week commitment phase has to be paid and covered in full wether you finish earlier yourself or not it will still need to be paid. 98% of ladies who work with ND Academy stay on to optimise long lasting results. If you are finishing up on the 12 week commitment phase, you will still need to give a months notice by letting me know on week 8 of 12. This is important as payments are non refundable and the subscription will continue unless one months notice is given. PLEASE READ THE T's & C's FORM IN FULL FOR MORE INFORMATION ON THIS :: * I have read and understand this fully

Do you mind progress photos being shared on social media? Would you prefer your name mentioned or name and face removed? The reason I share these results is because I want to give ladies like yourself an opportunity to see what can be achieved when you put your mind to it and it was probably from seeing other ladies results is possibly one of the reasons you took the leap so you have an opportunity of helping others look after themselves too!:: *

Are you ok with your name being mentioned on social media upon starting with ND Academy?:: *

Referral scheme - Did someone recommend My online coaching service to you? If yes, please specify their name. If no, please specify why you chose me to be your coach?:: *

What setbacks do you feel you might face?:

How did you react to these setbacks before and how do you intend on reacting to them now?:

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