Name *

First Name

Last Name

Age *

18-25

26-35

36-45

46-55

55 and Over

Do you live near, or would be willing to travel to Lucan or Castleknock, Dublin? *

Yes

No

Have you ever had an Online Coach before?

Yes

No

Do you have any nutrition restrictions?

Yes

No

Do you currently have access to a gym? *

Yes

No

No, but I could get access to a gym for online coaching

No, but I would prefer to train at home

No, but would prefer to train with a group and do classes

Are you free for Personal Trainings in...

(Tick as many boxes that apply)

Early Morning (6am-9am)

Mornings (9am-12pm)

Afternoons (1pm-6pm)

Evenings (6pm-10pm)

Weekends

How much are you willing to spend per month to achieve your fitness goals?

Less than €50

€50-€100

€100-€200

€200-€400

More than €400

*

I am committed to achieving my Health & Fitness Goals in 2019

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Would you like to receive weekly insider tips to improve your health and fitness from me?

Yes

No