Name *

First Name

Last Name

Gender *

Male

Female

Phone *

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth *

MM

DD

YYYY

Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number *

Country

(###)

###

####

Do you vape or smoke? *

Daily

A few times throughout the week

Once a week, Social smoker/Vaper, destress

Rare occasions

Never

Fatigue levels *

5 = constant energy throughout the day, no crashing

1

2

3

4

5

Stress Levels *

1 = happy and content, never anxious, look forward to my day

1

2

3

4

5

Your daily nutrition *

5 = you eat plenty of fruit, vege and water, have minimal processed foods, feel great after each meal

1

2

3

4

5

Water Intake *

< 1L

1L - 2L

2L - 3L

> 3L

Activity levels *

Very inactive (e.g. sitting/laying on the couch or in bed most of the day)

Sedentary lifestyle (e.g. desk job, mostly seated throughout the day. )

Slightly active (e.g. student, some movement and standing)

Active (e.g. retail, hospitality, mostly standing and moving throughout the day)

Very active (e.g. Tradie, physically demanding job, workout consistently)

Vigorously active (e.g. Athlete, exercise is my life)

Training experience/age *

I have never participated in training

Novice - less than 12 months following a structured gym program

Intermediate - > 12 months following a structured gym program and I am competent in all the fundamental movement patters

Advanced - 5+ years of structured training experience and i am proficient in all the fundamental movement patters

How frequent is your current training?

I rarely train

Once or twice a week

3-4 times per week

5+ times per week