KhadijaKGym Survey Form
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Name
*
First
Last
Email
*
Mobile Number:
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Age:
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Date Of Birth:
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Residential Address:
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Instagram handle:
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Main reason for exercising
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Lose weight
Build lean muscle
Stress Management
Gain weight
Get fit
Time slot you will be attending:
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5am
915am
515pm
615pm
What would be your first choice if i added on a new class this year?
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Running Club
Boxing/Mma
Yoga
Strength/Powerlifting - squat - bench - deadlift
What would be your SECOND choice if i added on a new class this year?
*
Running Club
Boxing/Mma
Yoga
Strength/Powerlifting - squat - bench - deadlift
What are YOUR goals for 2023 in terms of training. give me details!
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Would you be interested in a weekly or monthly review with regards to your progress. EG; keeping track of your goals eg - weight, or how much you can squat etc. then progressing every week.
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yes
no
What supplements/vitamins do you take?
*
Do you have any medical conditions, illnesses, high blood pressure etc?
*
Emergency Contact:
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First
Last
Emergency Contact Number
*
Sign up to our newsletter?
How was your 2022 gym experience?
*
How many gym sessions a week will you attend this year?
Selected Value:
2
Any other recommendation's or feedback for 2023
*
Submit