Pre-Consultation Form

In order to undertake any service with Dean Zweck PT and Nutrition we ask all potential clients to complete the following Pre-Consultation Form, in detail, so we can get a better insight into you, your background and your goals.

We will endeavor to get back to you with our Service Brochure, which lists all of our services with associated costs within 1-3 working days. If required, we can also personally recommend a service based on your individual goals and budget…

Personal Details

Please expand on your goals below including ranking them in order of importance *

Your Current Diet

Please give details below if possible on a typical day's food intake

Do you use any supplements/medication? *

Yes No

Have you used any supplements/medication in the previous 12 months? *

Yes No

If Yes, please give details here: (brand, quantity etc) *

Support

The different services we offer vary in terms of the level of support, time and client effort required. To better help advise you on the most appropriate and effective service for your individual goals, please indicate the budget most applicable to your current situation. *

< £100 £100 - £200 £200 - £500 > £500

If we end up working together, what does success look like to you in 3 months, 6 months and 12 months?

Current Training/Exercise

Movement preference #moSTYLE

When it comes to exercise, do you prefer? *

Structure Freedom Both

When it comes to exercise, do you prefer? *

Routine Variety Both

When it comes to your spare time, do you prefer activities that are more? *

Practical Adventurous Both

Females only

Would you be willing to provide a testimonial and/or before and after photos (if applicable) for the website and/or social media? *

Yes No

Do you have access to Skype/Facetime should your consultation need to be remote? (Face to face is located in Bury) *

Yes No