Fitness Coaching Enquiry Form
Are you a submissive man or woman who needs some motivation to get into shape, or are you a Dominant man or woman who wants someone to motivate your submissive into action to get into shape? Either way, get in touch with me to discuss how we can work together to make you or your beloved submissive healthier and happier, whilst enjoying a power dynamic.

Please note that you cannot save this form, so please ensure you have all the information you need to complete it before you start.
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Email *
Name and Date
Your name and today's date
Communication Preferences
For the purposes of responding to this enquiry and setting up sessions, please confirm that I can use the email address you provided to discuss fitness and your kinky preferences.
Can I use the email address provided to discuss your fitness and kinky preferences? *
If you responded 'other' to the above question, then please provide an alternative means of communication. *
Name *
Date *
Where in the world are you located? *
If you are in the UK, please provide a specific area.
Please let me know what you are hoping to achieve from my coaching.
Who is this coaching for? *
What is this coaching for? *
When would you like to start this coaching? *
Marketing Information
Please let me know how you heard about my Power Dynamic Fitness Coaching?
How did you hear about me? *
Your Kinky Interests
Tell me a little bit about your interests and experience of kink.
Your primary kinky interests *
Your experience of kink *
Your soft limits *
Your hard limits *
Physical Activity Questionnaire
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below.

If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions.

Please read the questions carefully and answer each one honestly: check YES or NO.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had chest pain when you were not doing physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart conditions? *
Do you know of any other reason why you should not do physical activity? *
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