Lifestyle Health and Fitness

Consultation PT

Consultation form

The consultation form allows me to gather more information about you, any illnesses or injuries you may have or have had in the past. It also allows you to tell me what your health and fitness goals are, exercise preferences you have and what you would like to try. Be as honest and as in depth as possible.

Please complete and submit this form.

 
Name *
Name
Gender *
Have you or your family had any of the following? * *
Do you smoke? *
Have you ever smoked? *
Have you ever injured any of the following areas of your body? *
Which of the following fitness goals are important to you? * *
I want to:
Which of the following health and lifestyle goals are important to you? *
I want to feel:
Which other health and lifestyle goals are important to you? *
I want to have:
How important to you is it that you achieve the goals you have chosen? *
What areas are you willing to work on to achieve these goals? *
In your experience, which phrase best describes your motivation levels? *
From the following list, who is supportive of you achieving your goals? *
From the following list who is NOT supportive of you achieving your goals? *
Treadmill Rower Spinning bike