Jo Spaull Fitness | Consultation

Personal Details

Name: *

Email: *

Address:

Date Of Birth: *

Telephone: *

Job Role:

Details of journey to work:

Work start time:

Work finish time:

Stress level of position: (between 1-5 with 5 being highest)

Nutrition

What do you eat for breakfast?:

What do you eat for lunch?:

What do you eat for dinner?:

Do you snack? If so, when? What on?:

Do you get your 5-a-day?:

How many days a week do you eat out / have takeaway?:

How much water do you drink daily?:

How many days a week do you drink alcohol?:

Out of those, how many times do you drink more than 2 glasses?:

Do you drink caffeine? How much?:

Lifestyle

What time do you go to bed?:

What time do you get up?:

Do you smoke? If so, how many?:

Other

Do you have any injuries, if so details?:

Are you on any medication?:

Are you pregnant?:

What is your current UK dress size?:

Anything else you feel I should know?:

How many times a week would you like personal training?:

Exercise

Please summarise your exercise history:
(please include likes / dislikes)

Goals & Targets

What are you hoping to achieve from personal training?:
Please be as specific as possible – SMART (Specific / Measurable / Achievable / Realistic / Timebound)