Lifestyle Formulier
Welcome!
After submitting this form you will be contacted by one of our certified personal coaches for a free try-out session. The information you will provide in this form will be strictly confidential and only be used to make your try-out session as personal as possible.
Congratulations for taking the first step towards a more active and FUNctional lifestyle!
#youarefunctional
* Required
Email address
*
Your email
Name, Surname
*
Your answer
Year of Birth
*
Your answer
Telephone
*
Your answer
Postcode + Location
*
Your answer
Where did you hear about us??
*
Choose
Brochure/flyer
Word of mouth
Website
Social Media
Referral by a Coach
Do you have a particular preference for a coach?
Your answer
Why are you interested in Functional Training? Please check all that apply
*
To change my body figure
To improve my health
To better cope with stress
To have fun!
To improve sports performance
To start an active lifestyle
Other:
Required
LIFESTYLE
Do you smoke?
*
Choose
Yes, regularly every day
Yes, once in a while
NO
Do you drink alcohol?
*
Choose
Yes, regularly every day
Yes, once in a while
No
What's your current stress level?
*
Very relaxed
1
2
3
4
5
Extremely stressed out
What are your main sources of stress?
Your answer
When were you in the best shape of your life? How did your life look like back then?
Your answer
Have you been exercising consistently for the past 3 months (>3 times/week)?
Choose
Yes
No
If NOT, why not?
Your answer
EXERCISE
On a scale of 1-10, how would you rate your present fitness level
Very bad
1
2
3
4
5
Excellent
Clear selection
When did you first start thinking about becoming more active?
Your answer
How often do you take part in physical activity? (Minimum 30' mins, low intesity like cycling to work, gardening, walking the dog...)
Choose
1-2 maal/week
3-4 maal/week
5+ maal/week
Do you practice any sport or more vigorous physical activity at the moment?
Your answer
If you're less active than you would like to be, what are the reasons?
Lack of interest
Injury, pain, disease...
Lack of time
Lack of motivation and/or inspiration
Lack of knowledge of how to do it
Other:
What has prevented your from reaching your fitness goals in the past?
Your answer
Have you had major injuries in the past? Do you still suffer from it?
Your answer
Preventief Sportmedisch Onderzoek (facultatief)
SORRY, THIS ONLINE TOOL IS ONLY AVAILABLE IN DITCH
Dit online-instrument is ontwikkeld voor iedereen die sport of van plan is te sporten. Wil je te weten komen of een sportmedisch onderzoek raadzaam is, hoe vaak dat moet gebeuren en wat er onderzocht zal worden, dan ben je hier aan het juiste adres! Alles hangt af van je leeftijd, de sport die je beoefent en de intensiteit ervan.
https://www.sportkeuring.be/
DESIGNING YOUR PROGRAM
Which goals you would like to reach in the next 3 to 6 months?
Your answer
How will you feel once you’ve achieved these goals? Please try to be specific. "Happy" is good, but else..?
Your answer
How can your personal trainer help you in achieving your fitness goals?
Your answer
Outline any obstacles, potential actions, behaviors or activities that could limit your progress towards accomplishing your goals?
Your answer
Realistically, how often (times/week) do you think you should exercise to reach your goal(s)?
Your answer
THANK YOU!
Your personal data are sefe with us.
We appreciate your trust in us and therefore we guarantee that we will treat these information with the maximum care and NOT share/sell them in ANY case to third parties.
A copy of your responses will be emailed to the address you provided.
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