PD New Client

Please answer all fields with as much detail as possible

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Sex *

D.O.B *

Weight *

Height *

What is your goal? *

When would you like to achieve it by? *

On a scale of 1-10, 10 being extremely important. How important are your goals to you? *

What has stopped you from achieving your goal and maintaining results in the past? *

Services of interest *

Personal Training Online Coaching

Please list any injuries (Give as much detail as possible) *

Please give as much information regarding your current diet (Food likes/dislikes, How many meals per day?) *

Please give information on your current & past exercise level (Have you attended a gym previously) *

Please list any other medical conditions (Including allergies & Intolerances) *

Do you smoke? *

Yes No

Please list any medication you are or recently have been taking. *

Do you use sports supplements? *

Yes No Prefer not to

Progress Photo - FRONT *

Max file size: 20MB

Progress Photo - REAR *

Max file size: 20MB

By checking the below box I hereby state that all information is true and answered to the best of my ability. *

Acknowledge

I acknowledge that Paul Davis will not be held liable for any medical conditions or injuries. *

Acknowledge

Lets Start