GET FIT PROGRAMME FORMS

THERE ARE four SHORT FORMS YOU SHOULD COMPLETE AND SHARE BEFORE YOUR FIRST CONSULTATION

1. HEALTH

(Either download the health & lifestyle form as a pdf and send it completed to getfit@bodybycathy.com or complete the form below.)

It's important we have a complete picture of who you are, your lifestyle and your goals. Be honest in your answers and trust that whatever you share with us will be keep confidential.

2. Lifestyle

This form is dedicated to your lifestyle. There isn't a right or wrong answer, but it is important you answer honestly (even if the honest answer is you have never exercised in your life—that's why we are here).

Name

First Name

Last Name

Email Address

Phone

Enter the numeric country code (e.g. +44 for UK) and do not include '0' when entering your phone number. For example, +44 555 666 7777

Country

(###)

###

####

Emergency contact name and number

Birthdate

YYYY

Please answer the following questions with yes or no, providing additional information in the box below.

Do you have heart disease or any heart conditions you are aware of?

Do you have high blood pressure?

Do you have type 1 or type 2 diabetes?

Do you have any gastrointestinal problems?

What medications are you taking, what dose, how often and when was your last GP review?

Do you have food allergies or intolerances? If yes, please list.

Do you have joint problems

Have you had surgery within the past year? If yes, what surgery did you have and when was it performed?

Do you experience chest pain, wheezing or dizziness when walking up stairs?

Are yo pregnant or breast-feeding?

Do you have trouble sleeping? If yes, is it every night or occasionally?

Do you suffer from depression?

Are you a smoker?

Are there any other health conditions or concerns we should be aware of?

Name

First Name

Last Name

Email Address

Over the last five years, how would you describe your physical activity?

Over the last year, have you changed your physical activity? What did you try (or try to do)? How did those changes make you feel?

If exercise is already part of your life, describe what you do. Cardo, strength, yoga, walking, etc.

How many hours per week can you commit to exercise?

What limitations, if any, do you have to exercise? This can include gym membership, equipment at home, space at home, lack of exercise knowledge, lack of confidence, fitness level, health issues, money, time or anything else we should know before creating your personalised fitness plan.

Are there any types of exercise you like?

Are there any types of exercise you don't like?

What is your favourite food? You can include a few guilty pleasures, but focus on the types of fruit, veg, protein and grains you like.

What food do you hate?

What does success look like to you? Be creative when answering. Is it looking good in a bikini, being able to fit into your wedding dress, a perkier bum, no more bingo wings, more energy, run in a marathon? Think big and answer even bigger.

Is there anything else we should know about you?

DOWNLOAD HEALTH & LIFESTYLE

3. GOALS

(Either download the goals form as a pdf and send it completed to getfit@bodybycathy.com or complete the form below.)

You found Body by Cathy for a reason. What is it? What do you hope to accomplish? We want to understand how you found us, your goals and your commitment, We also want to know a bit more about your passions and a sense of who you are—everything relates to your Get Fit journey and how we can empower you to succeed. Please be as open as honest as possible.

Name

First Name

Last Name

Email Address

Phone

Enter the numeric country code (e.g. +44 for UK) and do not include '0' when entering your phone number. For example, +44 555 666 7777

Country

(###)

###

####

What prompted you to search for Body by Cathy? Was it a specific event? Was it advice from your GP? Was it a suggestion from a friend. Be specific

What do you hope to accomplish

Check all boxes that apply

Lose weight

Get lean

Get fit

Improve performance

Have more energy

Sleep better

Look and feel younger

Fight disease

How do you feel right now, completing this form and taking your first step toward getting fit? Excited? Scared? Empowered?

What does success look like to you (i.e. how will you know when you've reached it)? Is it a number on a scale, a dress size, faster running speed, more energy, better sleep, lower cholesterol? Whatever it is, be specific (even if it's something you think is unrealistic).

How much time are you able to commit to reaching your goals?

What are your passions? You might wonder how your answer to this question relates to your fitness goals, but who you are, what you do and what excites you directly influence your fitness goals. Besides, we want to know you better.

DOWNLOAD PDF OF GOALS FORM

4. FOOD DIARY

Download this form and record everything you eat, including what time and how much. Pay close attention to how you feel before and after you eat. Consider this your first step toward becoming more aware of your emotional connection with food.

It can seem daunting at first to measure how much you eat, but it gets easier and we've included a cheatsheet below.

3-4 oz fish = size of cheque

3 oz meat = size of mouse

½ cup rice = half a baseball

½ spaghetti = 10p size bundle

1 oz cheese = 6 dice

1 cup leafy greens = 2 fists

1 cup broccoli = 6 small florets

1 cup cauliflower = ¼ head

1 cup strawberries = 7 large

1 cup tomatoes = 1 large

1 cup melon = 1/8 of large melon

1 cup cereal flakes = 1 fist

1 pancake = 1 cd

1 teaspoon butter = 1 dice

150g pasta and rice = tennis ball

30g cheese = standard matchbox

30g nuts = a handful

180g potatoes = computer mouse

5g butter = one teaspoon

11g olive oil = one tablespoon

25g crisps = a mug

80 g lean meat, oily fish and chicken = a deck of cards

150g white fish = a chequebook

30g cheese = standard matchbox

DOWNLOAD FOOD DIARY

GET FIT FORMS

GET FIT PROGRAMME FORMS

THERE ARE four SHORT FORMS YOU SHOULD COMPLETE AND SHARE BEFORE YOUR FIRST CONSULTATION

1. HEALTH

2. Lifestyle

3. GOALS

4. FOOD DIARY