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First Name

Last Name

Phone

Country

(###)

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####

Date of birth

MM

DD

YYYY

What are your goals now? *

What is your priority for this month?

Still hoping to lose fat and see the scale go down

Ready to focus on building muscle/strength. Not super concerned with the losing fat.

Gain strength / endurance / athleticism - my performance working out is my priority

Cleaning up my diet, I just want to be healthier overall.

Just maintaining consistency

Increased flexibility / mobility

Other

What do you want to really get out of Online Personal Training?

Motivation and accountability

Guidance with training / working out

Help with changing my diet and eating healthier

All of the above

How ready and focused are you to put in work this month?

1

2

3

4

5

6

7

8

9

10

What kind of workouts do you want to do this month?

I want to continue what we did last month, I just hope to see progress and improvement

Cardio based (walking, treadmill, bikes etc)

At Home workouts

Gym workouts

Kettlebell

Lifting weights

What kind of training have you done since we last worked together?

I took a break. So I'll be ready to hit it hard when we start again!

I focused on walking and getting steps in.

I workout 3x a week or more

I'm still struggling to find time to workout, Im hoping to ease my way into while working with you.

I don't have time, and I'm ok with that. I mainly want to focus on diet for now.

What would you like to do diet wise?

Check all that apply

I'm still interested in counting calories.

I'd like to stop tracking calories and focus on eating more intuitively and getting help from you for that.

I'd love more meal ideas, healthy recipes and general rules to help me learn how to eat healthier.

I'm feeling confident about my diet and really want to focus on training/ my workouts with you.

Tracking progress

I will request updated photos & measurements from you to continue our coaching.

I'm willing to send photos to continue my coaching

I'm willing to take new body measurements when requested

I'm willing to weigh myself on the scale when requested

I am not comfortable sending photos to my coach

I do not want to use the scale or do any of the above.

Payment information *

Because you have worked with me in the past, you have the option to do month to month coaching! The cost is £140 (~ $180 usd) each month. Use the link below to pay the full £140 GBP to secure your spot. Please pay in GBP £ Please add your full name when completing the payment (as a note if possible). I do not provide refunds or transfers for services. There may be risks with participating in activities mentioned for individuals in poor health or with pre-existing physical or mental health conditions. If you choose to participate with these risks, you do so of your own free will, knowingly and voluntarily assuming all risks associated with such dietary practices and activities. These risks may even also be in existence for those who are currently in good health at the present time. As with any exercise program you assume certain risks to your health and safety. Any exercise program can cause injuries. It is possible that you may become injured doing the exercises in your program, especially if they are done with incorrect form. If you choose to participate in these risks, you do so of your own free will, knowingly and voluntarily assuming all risks associated with such exercise activities. These risks may also exist for those who are currently in good health at the present time. I am not a medical doctor or nutritionist. You must consult your doctor before beginning any nutritional or exercise program. It has been made clear that Ashley Quarles or Ashleysayque is not responsible for any injuries or health problems you may experience or even death as a result of using any services provided. I am not a licensed nutritionist, doctor or dietician. Follow at your own risk.

I understand and agree