Name *

First

Last

Email *

Phone *

Are you currently a member of Revolution Fitness? *

Ah yeah I am!
Nope...

No problem if you're not :)

Height (cm) *

Weight (kg) *

Please enter your weight - It helps ups calculate your macros, energy expenditure/intake and more.

Gender *

Have you been referred by another Fitness Professional? *

Yes
No

What is their name? *

Are your happy for us to keep them informed?

Yes
No

Perfect... Can we have their phone number please?

... and their email...

What's made you want the 90 Day Slim&Trim Plan?... Be as open and in-depth as you can be. :) *

There is no right answer here... Lose weight, tone up, feel better about yourself, improved energy levels throughout the day. Be open and really give us some insight into the meaning behind your goal.

Sleep Quality - Per night, on average

What time do you usually wake up...

How much water do you consume per day?

per glass, in litres or how ever you measure your water intake.

Are there any foods you consume 'too regularly' that you feel you shouldn't...

Smoker

Alcohol consumption, per week.

Current Activity Level / Exercise per week

What styles of exercise are you happy to par-take in AND are you currently taking part in any fitness regimes?... If so, please gives us details and examples.

for example; - I like walking, swimming and doing some light lifting. - I'm training for a marathon and follow 'X' Programme. - Revolution Fitness Academy. - I go to the gym. - I take part in fitness classes. - I follow a specific gym program.

Please tick the boxes below for the styles of exercise you are happy to take part in, in your local area:

Feel free to tick as many as you need...

If there is anything else, please tell us below.

How many times each week are you happy to dedicate to exercising? *

What eating methods or programs have you had success with in the past? *

Is there a particular time of the day you CAN’T STAND EATING!?

First thing in the morning, yuk!
I’m not an evening eater.
If there’s food in front of me, I’ll eat it.

Eating Style... *

If you've ticked 'something else' please let us know below...

Food allergies... Do tell... :) *

Such us, Gluten intolerant, FODMAP or any other intolerances and allergies you make have.

What is your favourite food?

Please list the food’s you really don’t want to eat.... *

We will do our best to accommodate these, but your objectives will take priority.

Can you give us an example of an ideal BREAKFAST, LUNCH and DINNER that would suit your lifestyle... *

Everybody’s different, we like to make sure your meal plans a sustainable. These examples help us look for the right type of meals for your lifestyle.

Any medical history we need to know about? *

Does you family have a history of any recurring medical issues?

Are you currently taking any supplements?

- Multivitamins - Whey Protein - Meal Replacements

Please read the below and sign here... *

By signing here you agree to allow Revolution Fitness to hold your information and contact you via email, text and phone to communicate regarding your 90day plan. You also agree that all the information you have given us is correct and to your knowledge, there is no medical reason why you can not take part in meal adjustments and exercise regime. If you do know of any medical reason or have any concerns regarding your health, please call your doctor. We do not diagnose or treat medical issues and we do not prescribe meal plans.

Slim & Trim 90 Day *

Only £30 per month!

Total

£ 0.00

Stripe Credit Card *

Card

Name on Card