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Consultation Questionnaire
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Step 1/7
Let's get to know you!
Date of birth
Gender
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Step 2/7
Work
What do you do for a living?
Rate your current daily activity level:
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Sedentary
Light active
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Labour intensive
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Step 3/7
Current training
Where do you train?
How many gym sessions are you performing each week?
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0-2
3-5
5+
Please note any other exercise outside of the gym:
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Step 4/7
Current diet
Are you currently counting calories? If so note how many calories you are currently on:
Do you follow any special diets or have any food allergies?
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Step 5/7
General health
Do you have any health conditions or injuries?
Are you currently taking any medications or supplements?
Do heart conditions or diseases run in the family?
Do you smoke cigarettes?
No
Yes
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Step 6/7
Your goals
How many training sessions can you commit to per week?
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0-2
3-5
5+
Please note the goals you would like to achieve whilst on the SammyShreds program:
What's your timeline to achieve these goals?
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12 weeks
6 months
1 year
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Your expectations
Pick your preferred coaching plan:
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Training Cycle Only Plan
1:1 Online Coaching
Personal Training
Summer Shreds Challenge
What are your expectations of your coach:
How motivated are you?
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Somewhat motivated
Motivated
Highly motivated
I have read & agree to the
Liability & Indemnity Agreement
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Done!
Thank you for your information. Please select your preferred time for a consultation:
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“Sam is very open and welcoming. I find that he tailors his approach/delivery to each individual.”
Sarah E
“Sam taught me that there were no ‘good’ or ‘bad’ foods, and helped me create an amazing relationship with the gym.”
Alex W