Personal Training Enquiry Form

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J.C Health and Fitness

Email *

About Julie Curtin; Nutritionist and Performance Coach

Hi, I'm Julie. I'm so glad that you decided to take this first step in your Health and Wellness Journey and I can't wait to start with you. Here are just a couple of questions for you to answer so I can make sure I'm the right trainer for you! Let's smash this and meet our goals!!

I do both in-person and online coaching, so we can work around a busy schedule. I also offer 24/7 WhatsApp support and guidance to all my clients as a part of their plan. Just know that we are in this together and I support you no matter what!

Full Name: *

Age: *

Phone Number: *

How did you hear about me? *

Personal Training and Lifestyle

This is a few questions for me to know where you are training and lifestyle-wise so that I can create the best plan for you!

Current Weight (if known)

What do you want to achieve through PT with me? (weight-loss, muscle gain, healthier lifestyle?) Give me as much detail as you can! *

What is your occupation? How active are you during your work day? *

Do you partake in exercise currently? If so, how often? *

1-2 Days a week

3-4 Days a week

5+ days a week

Other:

How much time can you dedicate to your training? (My PT sessions are usually 1 hour long) *

30 minutes

30-45 minutes

45-60 minutes

60+

How often do you want to exercise during the week? *

1-2 Days a week

3-4 Days a week

5+ days a week

Other:

Are there any exercises you enjoy that you want me to add into your plan? Or exercises you don’t like?

Health History; Do you have any health history or injuries that I should know about before creating a plan? *

Heart Problems, Chest Pain or Stroke

Increased Blood Pressure or Cholesterol

Any Chronic Illness or Condition

Recent Surgery

Pregnancy (now or past 3 months)

History of breathing or lung poblems

Muscle, joint or back disorder

Smoking

Hernia or any other condition

Other:

Required

Nutrition and Diet

I do offer Meal Plans, however if you would rather we can focus more on food guidance and education if this doesn't suit you!

Is there any diet you currently follow? (vegetarian, vegan, keto) *

Do you/Have you tracked calories before? *

Yes

Do you feel comfortable tracking calories? *

Yes

Other:

Is there anything you don't like/eat? *

Is there anything you can’t live without? *

How much water do you drink a day? *

1-2L

2-3L

3-4L

Your Own Personal Goals

Almost done!

What is your sleep like? How many hours do you usually get? *

On a scale of 1-10 how are your usual stress levels? *

What is your main goal during this process? *

What are your long-term goals (3 months/one year)? *

Do you have any questions for me as a Personal Trainer? *

Thank you for participating in my form, I will phone/message you or email you for your consultation ASAP

Send me a copy of my responses.

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