IAMFITNESS SKYPE CONSULT FORM
* Required
Name
*
This is a required question
Email
*
This is a required question
What are you looking for from I AM FITNESS online coaching?
*
Fat Loss
Lean muscle gain (toned)
Other:
This is a required question
What struggles do you feel i can help you with?
*
Training
Nutrition
Mindset/Attitude
This is a required question
How much have you invested previously into your healthy, fitness and lifestyle goals?
This is a required question
What has worked really well for you in the past? Is there anything that hasn't worked so well?
This is a required question
Why do you think you have not yet achieved the goals that you have set for yourself?
This is a required question
On a scale of 1-10, how happy are you with your body at the moment?
*
1
2
3
4
5
6
7
8
9
10
Not happy at all
Perfectly happy
This is a required question
On a scale of 1-10 how happy are you with your current training and your nutrition?
*
1
2
3
4
5
6
7
8
9
10
Not happy at all
Perfectly happy
This is a required question
Which of the below best describes what you are looking for from I AM FITNESS?
*
Sustainable results
Improved self-esteem both in and out of the gym
To feel like fitness isn't ruling your life
A drastic overhaul of your lifestyle
This is a required question
Which of the below best describes your approach to your fitness and nutrition - Please be honest
*
I make excuses for myself and look for easy ways out
I'm impatient. I want quick results and get bored easily
This is a required question
Please enter your Skype username/ID OR whatsapp contact number
*
This is a required question
What time zone are you in? This is so we can easily schedule a call.
*
This is a required question
Physical Activity Readiness Questionnaire (PAR-Q)
This is a required question
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor?
*
No
Yes
This is a required question
Do you ever feel pain in your chest when exercising?
*
No
Yes
This is a required question
In the past month, have you experienced chest pains when not exercising?
*
No
Yes
This is a required question
Do you lose your balance because of dizziness, or do you ever lose consciousness?
*
No
Yes
This is a required question
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in physical activity?
*
No
Yes
This is a required question
Is your doctor currently prescribing drugs for your blood pressure or heart condition?
*
No
Yes
This is a required question
Do you know of any other reason why you cannot perform physical activity?
*
No
Yes
This is a required question
Pick 2-3 dates and times you can skype/talk on the phone
*
Only Tuesday 3pm-6pm and Wednesday 3pm-6pm
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
Hr
01
02
03
04
05
06
07
08
09
10
11
12
:
Min
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
PM
Pick 2-3 dates and times you can skype/talk on the phone
*
Only Tuesday 3pm-6pm and Wednesday 3pm-6pm
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
2062
2063
2064
2065
2066
2067
2068
Hr
01
02
03
04
05
06
07
08
09
10
11
12
:
Min
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
AM
PM
Any questions?
This is a required question
I confirm that i have read, understood and accepted the terms and conditions outlined in the link below
https://docs.google.com/document/d/1-cKH7X_lteBNWLL86sjk3TGsPnIFQLZ4nFG3RFwvu7k/edit?usp=sharing
I accept the terms and conditions as outlined above
This is a required question
Your signature (just to make sure you are human) - simply type in your name
This is a required question
Never submit passwords through Google Forms.