What is your age? *

30-45

45-55

55+

How active is your work life - Score 1-5 (1 being lowest 5 highest) *

1

2

3

4

5

Your occupation? *

How many hours a week can you find to train? *

0-2

2-3

3+

How often do you drink alcohol? *

Never

Occasionally (a couple of times a month)

Often (a couple of times a week)

How many hours of sleep do you get each night? *

Less than 5

5-7

7+

How would you rate your levels of stress? 1-5 (1 being lowest 5 highest) *

1

2

3

4

5

How much weight would you like to lose? *

None - I want to gain weight

Less than 10kg (22lb)

More than 10kg (22lb)

How often do you get takeaway food? *

Less than once per week

1-2 times per week

2+ times per week

How many push ups can you do? Please test *

How would you rate your health 1-5 (1 being lowest 5 highest) *

1

2

3

4

5

Do you have children? *

Yes

No

What have you tried before to reach your goals? *

What was good about it? *

What was it lacking?

Describe your goals in more detail *

What is your motivation behind these goals? How will it improve your life? *

How would you like to see yourself? Describe in 3 words. (motivated, disciplined etc) *

Are you a reliable person that will follow coaching advice, listen and show up? *