P365 Client QuestionnaireStep 1 of 333%Name* First Last Address* Street Address Address Line 2 City ZIP / Postal Code Email* Date of birth* DD slash MM slash YYYY Height CM*Current Weight KG*Lowest bodyweight in last 24 months KGHighest bodyweight in last 24 months KGMedical Information:Are you suffering from any current injuries?*YesNoPlease explain your current injuries in more detail*Have you experienced any injuries recently?*YesNoPlease explain your recent injuries in more detail*Do you suffer from any back pain or discomfort in any area of the body currently?*YesNoPlease explain your back pain or discomfort in any area of the body in more detail*Do you experience any tension or soreness in specific areas of your body?*YesNoPlease explain any tension or soreness in specific areas of your body in more detail*Do you feel overly tight in any area of your body?*YesNoPlease explain where you feel overly tight in any area of your body in more detail*Do you have difficulty sleeping at night?YesNoPlease explain why you have difficulty sleeping at night in more detailDo you ever experience fatigue or lack of energy throughout the day?YesNoPlease explain your fatigue or lack of energy throughout the day in more detailAre you currently taking any medication that I need to be made aware of?*YesNoPlease explain which medications you currently taking that I need to be made aware of in more detail*What would you like to achieve in your time working with me?When would you like to achieve the above goals by?What is the main reason and driving factor(s) for wanting to invest in yourself and make this change?Training Likes and Dislikes, if you feel something’s worked for you, let me know about itWhat does your current weekly training schedule look like?How many days are you willing to train to achieve your goals?*1 day per week2 days per week3 days per week4 days per week5 days per weekDo you currently have a gym membership?Please chooseYesNoDo you drink coffee? If so, how much and what type?How many hours a day do you spend seated – Car, train, home etc?*1 Hour2 Hours3 Hours4 Hours5 Hours6 Hours7 Hours8 Hours8+ HoursWhat time do you usually go to bed at night? : Hours Minutes AMPM AM/PMWhat time do you usually wake up in the morning? : Hours Minutes AMPM AM/PMDo you have trouble going to sleep at night?YesNoDo you struggle waking up in the morning?YesNoDo you ever use medication to enable you to get to sleep?YesNoOn average, how many times do you get up to go to the toilet in the night?Never1 Time2 Times3 Times4 Times4+ TimesDo you feel stressed?YesNoWhat are the main stressors in your life?How do you manage increases in stress?Do you track your food intake? Rate your eating out of 5 (5 being best)?*12345Signature