Log In
Welcome
1:1 Personal Training
Virtual PT
Classes (Leicestershire)
Online Classes
Ask a Question
Mum&Mia
Log In
Welcome
1:1 Personal Training
Virtual PT
Classes (Leicestershire)
Online Classes
Ask a Question
Name
First Name
Last Name
Email
*
Mobile number for your weekly check in
*
(###)
###
####
Date of Birth
*
What is your occupation?
Please tell me how active this job is e.g are you mainly sitting or do you walk around a lot? Also if you are working from home.
How would you describe your current lifestyle?
*
Sedentary (Little or no exercise)
Lightly Active (Light Exercise /sport 1-3 times a week)
Moderately Active (Moderate exercise 5-7 times a week)
Very Active (Hard exercise every day)
What exercise are you currently doing (if any)?
Please include intensity of the exercise and time e.g. walk the dog for an hour a day - slow pace). Leave blank if no exercise
What type of exercise do you enjoy?
Short High Intensity Workouts
Toning Workouts/Weighted Workouts
Dance/Aerobics Style Workouts
Yoga
Pilates
Walking
Running
What results are you looking for?
Improve Fitness
Improve Health Generally
Lose Fat
Tone Up/Get Stronger
Reduce Stress
Increase Flexibility
Improve Mental Health
All of the Above
Why do you want to do do this/What is making you want to make these changes to your life?
Height
*
Current Weight - please also state whether are currently maintaining this weight, gaining weight or losing weight
*
Goal Weight (if wanting to lose weight).
Please include any specific timeframes if you have a date in mind or special event.
(If applicable) What is it that you think may have caused you to gain weight?
e.g. too much snacking on unhealthy foods, large portions
Resting Heart Rate
If you have a smart watch/fitbit/heart rate monitor etc please let me know your resting heart rate after sitting down and relaxing for a 5 minutes. This can also be done by taking your pulse in your neck or wrist and counting the beats for one minute.
On a scale of 1-10 how well do you sleep?
With 1 being really bad and 10 being excellent)
On a scale of 1-10 how would you rate your body confidence?
(with 1 being really bad and 10 being excellent)
On a scale of 1-10 how would you rate your energy levels?
With 1 being really bad and 10 being excellent
On a scale of 1-10 how fit do you feel?
With 1 being very unfit and 10 being super fit
On a scale of 1-10 how would you rate your stress levels/mental state?
With 1 being very bad and 10 being excellent
How much time and when do you have time to exercise each week?
Please include any specific days, times and length of time available.
Is there a specific area of the body that you would like to focus on?
If applicable, when did you have your last baby? Please include whether the birth was natural or c-section and whether you suffer from any issues from the birth or pregnancy.
What equipment do you have available for home workouts (if any)?
How many glasses of water would you say you drink during the day?
How many portions of fruit and vegetables do you have each day?
How much alcohol do you drink during the week and what do you drink?
If you want to lose weight, is there any changes to your diet that you have made that is working?
To give me an idea of your usual diet, please can you tell me what you have eaten and drank over the last 3 days. If you can't remember, give me an idea of what it would usually look like or write a food diary for the next 3 day and send it to me in a separate email. Drinks and snacks included! Please be as honest as possible with this, there is no wrong but the more info I have the better I can support you.
On a scale of 1-10 how ready do you feel to start making healthy changes to reach your goal.
Do you feel that you have any barriers that may affect you achieving your goals?
Thank you! I will take a look through your form as soon as I can and get back to you
Sarah x
Member Login
Welcome,
(First Name)
!
Forgot?
Show
Stay Logged In
Log In
Enter Member Area
(Message automatically replaces this text)
OK
My Profile
Log Out