Client Questionnaire

NEW CLIENT QUESTIONNAIRE

Please complete the below form and return to me before your program start date. This wilL provide me with additional information about you and allow us to move forward together. Once you have completed this form we will set some goals together! It is important to have a short term, medium term and long term goal and these will help us to continue moving towards that end outcome goal!

Please answer in as much detail as possible so that we can make the best decisions going forward. All information is strictly confidential.

NRF Client Questionnaire

Full Name

Date of Birth

Home Address

Telephone

Social Media Handle

Email Address

Emergency Contact Name

Emergency Contact Number

Occupation

Do you smoke?

Height

Fasted Weight

Chest Measurement

Waist Measurement

Belly Button Measurement

Hip Measurement

Glute Measurement

Left Thigh

Right Thigh

Left Arm

Right Arm

When was the last time you participated in physical activity? If so, what types of exercise do you participate in and how often?

When did you begin exercising and what different styles of exercise have you tried previously?

Do you currently own a fitness tracker? If yes, roughly how many steps do you achieve per day?

Are you planning to train at home or in the gym? If you are training at home, what equipment do you currently have access to?

How many days a week do you have available to complete your workout sessions?

What would you like to achieve as a member of Team NRF? When would you like to achieve this by?

What are your current outcome goals (non scale focussed)?

What does your diet look like on a daily basis? Please give details of all meals on an average day including the usual times that you would consume these meals.

What are your portion sizes like? How often do you eat throughout the day?

Does your diet change from weekdays to weekends?

How much water do you drink per day? Please give your answer in litres.

Do you drink tea or coffee? If yes, how many cups per day?

What other liquids do you drink? How much per day and how often? Include the types of liquid.

Do you drink alcohol? If yes, what type, quantity and frequency?

Have you ever tracked your calories and/or macros using My Fitness Pal?

What food likes and dislikes do you have? Do you have any allergies or intolerances?

Do you take any dietary supplements?

Is there anything that you would like to add?

By ticking this check box I am signing to the terms of this form.

Yes I agree and sign as an agreement of consent.

Date

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NEW CLIENT QUESTIONNAIRE

NRF Client Questionnaire

NRF STRAIGHT IN YOUR INBOX? YES PLEASE!

The healthiest, happiest, most confident you!