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First Name
Last Name
Email
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Phone
Country
(###)
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Gender
Male
Female
Prefer not to say
Date of birth
MM
DD
YYYY
Height
What are your goals?
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Check all that apply
Lose ~30lbs (15kg) or more
Lose ~20lbs (10kg) or less
Gain Muscle mass
Gain Strength
Maintain Weight | Practice Healthy Habits
Increased flexibility / mobility
Other
Share your goals in your own words
What do you do for a living?
What's your activity level at work?
Not much (seated most of the day)
Moderate (light activity such as walking)
High (heavy labor, very active)
Please list any diagnosed health problems/conditions
If you have any injuries that can impact your workouts, please list them.
Do you use cigarettes / vape or smoke?
yes
no
Do you drink alcohol?
Yes, often
Yes, but not often
No
Your current diet could be best described as
vegetarian / vegan
keto
low fat
low carb
high protein
no special diet
other
if you selected "other" , please explain
What do you want the most assistance with?
Motivation and accountability
Guidance with training / working out
Help with changing my diet and eating healthier
All of the above
How ready are you to change?
1
2
3
4
5
6
7
8
9
10
How often are you willing to train a week to reach your goals?
What kind of workouts do you enjoy?
Cardio (running, walking, biking, at the gym or outdoors)
Yoga / Pilates
At Home
Gym
Kettlebell
Lifting weights
Other
How much experience do you have working out? Lifting weights?
How often are you currently exercising and being intentional about movement?
I workout 1-2x a week maybe.
I workout 3x a week
I workout 4x a week or more
I dont' make time for intentional movement currently, but I want to.
I don't have time, and I'm ok with that. I mainly want to focus on diet for now.
I regularly go for walks / track my steps
Do you have a fitness watch to track your steps? If so, which one?
What muscle group / body part do you most want to improve/develop?
What are your thoughts on calorie counting?
I'm familiar with counting calories. I've done it before
I've never counted calories, and/ or I don't know how
I do not want to count calories
Do you use an app to track calories? If so, which one?
Have you worked with a personal trainer before?
Yes I've worked with a trainer in person
Yes I've worked with an online trainer
No
Tracking progress
check all that apply
I'm willing to send physique photos when requested
I'm willing to take body measurements when requested
I'm willing to take scale measurements when requested
I am not comfortable sending photos to my coach
I do not want to use the scale
Payment information
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Online personal training is a 12 week minimum commitment at £160 (~ $200 usd) each month // Or £380 (~$480) if paid upfront and in full. Pay must be made in GBP. Any additional training/coaching assistance afterwards is month to month.
Use the link below to pay the full £380 GBP to secure your spot. Or you may pay for the first month to secure your spot, but please email me to set up a payment plan for the remainder. 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