online program form | Longford Fitness

Step

First Name*

Last Name*

Occupation*

Age*

Gender*

Height (in cm)*

Email*

Have you any injuries that may prevent you from completing this programme?*

If 'Yes' pleae provide further details*

What is your main goal for this program?*

Where do you plan to workout?*

Gym

Home

Outdoors

Other

Are you allergic to any types of food/drink?*

If 'Yes', please provide further details*

What are your goals for this plan

These can be in the form of losing inches/losing weight/decreasing body fat/increasing muscle mass or performance related e.g. I would like to be able to do 15 full press ups. Be as specific as you can…..

Goal 1*

Goal 2

Goal 3

Goal 4

Obstacles

Write down what obstacles you see, that may prevent/hinder you from reaching these goals?

Obstacle 1*

Obstacle 2

Obstacle 3

Obstacle 4

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Please confirm you have read and agreed to our terms and conditions*

Yes

We will be in contact within 48 hours with your personalised program