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
Email address *
Name, Surname *
Year of Birth *
Telephone *
Postcode + Location *
Where did you hear about us?? *
Do you have a particular preference for a coach?
Why are you interested in Functional Training? Please check all that apply *
Required
LIFESTYLE
Do you smoke? *
Do you drink alcohol? *
What's your current stress level? *
Very relaxed
Extremely stressed out
What are your main sources of stress?
When were you in the best shape of your life? How did your life look like back then?
Have you been exercising consistently for the past 3 months (>3 times/week)?
If NOT, why not?
EXERCISE
On a scale of 1-10, how would you rate your present fitness level
Very bad
Excellent
Clear selection
When did you first start thinking about becoming more active?
How often do you take part in physical activity? (Minimum 30' mins, low intesity like cycling to work, gardening, walking the dog...)
Do you practice any sport or more vigorous physical activity at the moment?
If you're less active than you would like to be, what are the reasons?
What has prevented your from reaching your fitness goals in the past?
Have you had major injuries in the past? Do you still suffer from it?
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?
How will you feel once you’ve achieved these goals? Please try to be specific. "Happy" is good, but else..?
How can your personal trainer help you in achieving your fitness goals?
Outline any obstacles, potential actions, behaviors or activities that could limit your progress towards accomplishing your goals?
Realistically, how often (times/week) do you think you should exercise to reach your goal(s)?
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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