Get Active Online - Questionaire
Please fill in this questionnaire with as MUCH details as you can. The more I know about your current habits and lifestyle the more I can personalise your program for you.
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Email Address *
Name
Address
Age
Height
Weight *
Occupation & Working Hours, Kids? (would like to get an idea of how busy your life is)
What is your NUMBER 1 goal? *
What other outcomes would you like to achieve during your coaching program? *
Why have you chosen now to change your lifestlye? *
What has stopped you from achieving your goals in the past? *
How much stress do you have in your life?
Please provide at least 3 days worth of eating, family meals etc. Be as detailed as possible Iinclude any beverages and total daily water consumption) *
Do you have any food allergies or food dislikes?
Do you drink alcohol, if so how often and how much? *
Is there any treats, drinks you want to be able to include? For example a Friday night drink with your partner or regular dinner out? *
Provide an overview of your current exercise routine? *
What exercise equipment do you have access to? *
What time can you allocate to exercise each week? What's realistic for you? *
Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke? *
Required
Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise? *
Required
Do you ever feel faint, dizzy or lose balance during physical activity/exercise? *
Required
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months? *
Required
If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months? *
Required
Do you have any injuries, illnesses, medical conditions that need to be taken into consideration? *
Required
Are you pregnant or had a baby in the last 6 weeks? *
Required
If you answered yes to any of the questions above please provide details. It is also recommended that you get clearance from your Doctor before embarking on a new exercise routine
Now's your chance to tell me anything about yourself any of the other questions might have missed! The more I know about you and your lifestyle the more I can help you!
THANK YOU!
Once I've recieved your questionnaire and payment please allow up to 5 working days for your program to be issued. If you've forget to tell me anything or you want to have a chat please email me on hilde@getactiveonline.com (no question is a silly one 😀) Looking forward to working with you ❤ PLEASE EMAIL Front/Back & Side Pictures through.
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