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Clarke & Co
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Pre Consultation Form
Please leave blank:
Date of Birth:
Current Weight (kg):
What is your primary training goal:
Improve general fitness
Improve body composition
Improve physical wellbeing
Improve sports performance
Please provide as much info as you like:
What would be your ideal outcome from working with us?
Are there any other things you wish to discuss in your consultation?
Have you seen any other professionals regarding these issues? If yes, please specifiy:
What roadblocks (if any) are hindering you reaching this goal?
Do you currently take any supplements? If yes please specifiy:
Do you follow any of these dietary frames?
None, I just eat!
Low carb high fat
Other (please specify below)
Please give me a brief breakdown of a typical days nutrition:
If "other" please specify:
Sport (list "fitness" if you're a fitness enthusiast / non athlete):
How many hours per week do you currently train?
Is there anything else you think we should know? e.g. medical conditions, special considerations, injuries etc:
Roughly, what is the breakdown of your training hours?
HIIT / anaerobic
Steady state / aerobic
Hours per week
Hours per week, Strength:
Hours per week, HIIT / anaerobic:
Hours per week, Steady state / aerobic:
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