Your Personalised Weight Loss Transformation Plan With 1-1 Coaching Throughout To Get Results!

APPLICATION FORM

Thank you for your interest in working with me 1-1 through your own personalised transformation plan

I need to find out a bit more about you and what your goals and expectations are in order to determine if you would be a good fit.

To ensure your application is processed efficiently please complete the below form giving as much detail as possible. The more detail you can provide the better I can help you.

Limited applications are accepted at any one time therefore and due to high levels of interest shown, if you do not complete the form fully or provide vague and non-descript answers I regret I will not be able to help you.

Mobile Number (required so I can contact you if your application is successful)

Are you female? I only work with women.

Which program are you interested in?

What is your CURRENT dress size & weight?

What is your GOAL dress size/weight?

How long do you think it will take to reach your goal?

Tell me a bit about yourself and list all your goals. Please be as detailed and specific as possible.

Why do you want to change? Why are your goals important to you?

On a scale of 1-10 how important are your goals? If less than 10, why?

What prompted you to apply for this program? Has anything changed/happened in order for you to take action?

What do you believe are your biggest challenges preventing you from achieving your goals?

What have you tried in the past? Please be specific, diets, programs, meal replacement systems etc.

List two reasons you haven’t achieved your goal in the past:

You are the most important investment you’ll ever make in your life. Are you willing to invest in yourself to get the body, health and results you want?

Are you 100% willing to commit your FULL effort to this program and this program only?

Are you willing to commit to working out 3-4 times per week?
(from where and how long will be discussed with you and based on your preferences)

The support network you have around you is crucial to your success. If you have a partner, do they know about your goals and if so do you have their full support with this?

When was the last time you did something for yourself?

Tell me about your current workout/training schedule, do you workout? If so how often, how long and from where? Please provide as much detail as possible

What are your eating habits like – talk me through your average days food and drink? Be honest and open.

Are you willing to start logging and monitoring your food?

If we were to talk in 12 months from now, what would have to happen for this to be a MASSIVE success?

Do you have access to a gym?

If not, do you have access to the following pieces of equipment
(NOTE: required for home workouts if you do not want to go to a gym)
ANKLE WEIGHTSKETTLEBELLDUMBELLSRESISTANCE BANDSNOT APPLICABLE I HAVE A GYM MEMBERSHIP

If you don’t have access to all of the equipment, are you willing to invest in them?
YESNO I’M ON A BUDGETNOT APPLICABLE I HAVE A GYM MEMBERSHIP

To your knowledge, do you currently have any of the following conditions outlined below?
(Please note: I may request a medical certificate if I feel it is necessary – please understand this is part of my duty of care)
NECK PROBLEMSSHOULDER PROBLEMSELBOW PROBLEMSUPPER BACK PROBLEMSLOWER BACK PROBLEMSHIP PROBLEMSKNEE PROBLEMSANKLE PROBLEMSWRIST PROBLEMSARTHRITISHIGH BLOOD PRESSUREASTHMAHEART PROBLEMSDIABETESCHRONIC CONDITIONSDIZZINESSDIASTASIS RECTI (AB SEPERATION)NONE OF THE ABOVE

Do you have Diastasis Recti (Ab Separation)?

Please detail in this box below any illnesses/injuries/conditions not listed above – Please type N/A if none

Are you taking any medication? If so please detail below or type N/A if not

Are you taking any supplements? If so please detail below or type N/A if not

If you are currently taking supplements and I can advise you of a healthier alternative (if necessary) are you willing to switch to a different brand?

Additional Notes/comments

By submitting the above details, I agree that the information I have provided is true and correct. I also agree that should anything change it is my responsibility to keep you updated.