Request edit access
Discovery Form
WELCOME ! Please take the time to fill out this form. The more info we have about you, the more we can help you.
Email address *
Full Name: *
Your answer
Postcode *
Your answer
Phone number *
Your answer
Your answer
Tell us a little bit about, what you have done before
So what has brought you here, and what outcome you are looking for.
Your answer
Are you currently doing any type of Fitness / Training?
If YES please give details, and whether you got the results you wanted.
Your answer
What is your preference for training? *
What have you tried in the past?
Your answer
Did you achieve your health and fitness goals?
If NO what do you think the main reason was you didn't succeed?
Your answer
Please provide us with as much information as possible
Do you consider yourself to have a healthy diet?
If NO, what is your biggest downfall?
Your answer
Do you have any dietary requirements? i.e. vegetarian, vegan, gluten free etc?
Your answer
Are you currently or have you ever tracked your food intake? If so how?
Your answer
Do you struggle with any of the following? *
Have you had help with your nutrition in the past? (ie Nutritionist, dietician etc)
If YES, please provide details - Was it useful?
Your answer
It is important that we have a history of your past injuries / pain in order to help you.
Do you have any current or past injuries that may affect your training? *
If YES, please provide details
Your answer
Are you currently suffering from an ongoing pain? (ie Back pain, shoulder pain, knee pain? etc)
If YES, Please provide us with details
Your answer
Have you ever had a Coach or Personal Trainer alleviate your pain through exercise intervention?
Please tell us a bit about your lifestyle...
Are you a smoker?
On average, how many hours sleep do you get?
Do you have any significant stress in your life? (ie Work, family etc)
If YES, please provide us with some details
Your answer
Do you have any health related issues
If YES, please provide full details
Your answer
Are you on any prescribed medications?
If YES please provide full details including any side-effects you may have,
Your answer
Are there any other issues that we need to know about?
Your answer
Thank you for taking the time to complete this form, we will be in contact with you very soon to discuss how we can help you.
Pure Fitness
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy