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Online Training Application Form
Please fill out this form honestly with as much detail as possible.
Tell us about you...
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Indicates required field
Name
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First
Last
Email
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Gender
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Male
Female
Prefer Not to Say
Other
Date of Birth (DD/MM/YYYY)
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Age
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Height
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Weight (taken immediately upon waking after using the bathroom, before eating or drinking anything)
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Medical history, past injuries, medications, etc.
Do you have an medical conditions I should be aware of? Any medications that you are currently (consistently) taking? Side effects of these medications?
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Do have any injuries (past or ongoing) that I should be aware of that would inhibit you from certain exercises? If so, explain in detail. Has a doctor cleared you to participate in exercise? *
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Do you smoke? If so, how often? (socially, habitually?)
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Do you drink alcohol? If so, how many units per week?
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Lifestyle...
What is your occupation?
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What is the activity level at your job?
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none (seated only)
moderate (light activity such as walking)
high (heavy labor, very active)
Tell me a little bit about yourself (home life, work life, social life, hobbies/interests)
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What does your current exercise regime consist of? (how many days per week do you exercise? what type of exercise do you participate in? how many hours per week do you participate in exercise? what type of exercise do you enjoy? what type of exercise do you dislike?) *
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What else do you participate in to keep active?
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Decribe your current diet to me. (around how many calories do you consume per day? what types of foods do you eat? how many meals do you eat per day? do you have any dietary restrictions? do you count macronutrients and if so, what is your current split? do you feel satisfied on the amount of calories you eat per day?)
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On average, how many portions of fruits and vegetables do you consume per day?
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How much water do you drink each day? (glasses/liters)
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Tell us why you would like to train with us and how motivated you are to succeed...
Please rate your motivation level to to reach your goal.
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1 - not motivated at all
2
3
4
5 - extremely motivated!
Please rate your readiness for change.
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1 - not ready at all
2
3
4
5 - ready and willing to do what it takes to make a change!
What are your short term and long term fitness goals? (physical, nutritional, mental; when writing these goals, think about the 'YOU' 5 years from now-what does the best version of you look like?)
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What has held you back from reaching you goals in the past?
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Do you have any negative feelings toward, or have you had any bad experience with exercise? (if 'YES', please give details.)
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Do you have any negative feelings toward or bad experience with food/nutrition-dieting in the past? (if 'YES', please give details.)
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How much time per week are you willing to devote to exercise? (minutes per day, days per week)
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Are you willing to commit to 3-5 days per week of exercise?
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YES, bring it on!
No, I'm not quite ready yet.
Do you have access to a gym? (if not, what equipment do you have readily available to you?)
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Do you agree to check in with me once a week and provide me with honest, accurate feedback along with measurements and progress pictures?
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YES I DO!
No, I'm not quite ready to do this.
What are your expectations of online personal training? What do you hope to achieve?
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As your online trainer, what can I do to best help you succeed?
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Waiver of liability: Please read
All physical training has inherent risks. To the extent permitted by law, we accept no liability for persons injured following our exercise, nutrition, well-being or any other advice. For the avoidance of doubt, clients also waive all liability that we may have for any accidents or injury, except as a direct consequence of our negligence. If any medical or other conditions arise that could affect your training with us, you shall let us know immediately by email. If you have any doubts, please consult your doctor prior to physical activity. All exercise, nutrition, well-being or other advice given to you by any persons associated with re:bourne fitness & nutrition Ltd. is taken entirely at your own risk.
Did you read and fully accept the liability waiver above?
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Yes
No (sorry for insurance purposes we will not be able to help you)
Just a few more questions...
Our online personal coaching prices start from £197 per month. Are you willing to invest at least this amount on your health & fitness?
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I sure am!
Not at the moment, but maybe in the future!
Would you be willing to write a review on our website/social media pages and give a testimonial of your experience throughout the program?
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Of course, not a problem at all!
No, I'm not ready to achieve my goals and share my success with the world.
Do you have a preference of trainer?
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Male
Female
Either is fine
I agree to receiving marketing and promotional materials
Submit
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About Us
SERVICES ▼
Personal Training
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