Pre Consultation Form

Who is your consultation with?

Name :

Date of Birth:

Height (cm):

Current Weight (kg):

Email:

What is the primary reason for contacting 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:

Regarding your primary reason for contacting us, what is your desired outcome? what is your main goal in this area? :

What roadblocks (if any) do you face in reaching your goal?

Do you currently take any supplements? If yes please specifiy:

Please give me a brief breakdown of a typical days nutrition:

Do you follow any of these dietary frames?

If "other" please specify:

Sport (list "fitness" if you're a fitness enthusiast / non athlete):

How many hours per week do you train?

Is there anything else you think we should know? e.g. medical conditions, special considerations etc? :

Roughly, what is the breakdown of your training hours?

	Strength	HIIT / anaerobic	Steady state / aerobic
Hours per week	Hours per week, Strength:	Hours per week, HIIT / anaerobic:	Hours per week, Steady state / aerobic: