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First Name

Last Name

Gender

Date of Birth

Email

Contact number

Current Location (City & Country)

Height (metric or imperial units):

Current Weight (metric or imperial units):

What service are you interested in?

What are your main health & fitness goals?

Fat (Weight) Loss Increase Muscle Mass Athletic Performance General Lifestyle Rehabilitation & Corrective Exercise Nutrition Coaching Other

On a scale of 1 to 5, what would you consider your current physical activity level? (1 being sedentary and 5 being extremely active)

How many hours of sleep do you get per night (on average) ?

Do you currently have any injuries or illnesses? If yes, state below

Do you currently exercise or participate in any sports/gym classes or physical activities?

On a scale of 1 to 5, what would you rate your current fitness level? (1 being extremely unfit, 5 being the fittest)

On a scale of 1 to 5, how experienced are you with resistance/weight training? (0 being none, 5 being advanced)

What facilities do you have available to carry out workouts?

Commercial Gym Home Gym Limited equipment None

On a scale of 1 to 5, how healthy would you consider your current diet? (0 being extremely unhealthy, 5 being very healthy)

Do you have any digestive/gut issues? If yes, please state below:

Do you have any food allergies?

Have you been on any type of diets before? If yes, please state below:

If you have any additional information that Anmol may need to know of, please state below:

How do you prefer to be contacted?

Email Phone Call Text Whatsapp

TRAINER & COACH

ANMOL RAI
Personal Trainer
Strength & Conditioning Specialist
Corrective Exercise Specialist
Nutritionist

Next Step:

You will be contacted within 48 hours of your form submission.

If you do not receive an email or a text within 72 hours latest or encounter any technical issues, please directly contact Anmol. Contact details provided at the bottom of this page.

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Anmol Rai, Kinetic Steps
Personal Trainer & Nutrition Coach
Farnborough, Hampshire, England, UK.
Phone: (+44) 7525293182
Email: [email protected]

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