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Registration Form

To register, please take the time to fill out the information below.

Personal Details

First Name

Last Name

Address

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Post Code/ Zip Code

Email

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Age

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About You

Please answer the questions below honestly

What is your Height?

What is your current weight?

Do you have a disability?

What are your current health and/or fitness goals

To lose weight/fat

To tone body and/or gain muscle

To be more confident

To improve health & fitness

To gain more enerrgy

To become more flexible

What do you ideally want to achieve whilst working with Kelly? Do you want to feel healthier, fitter have a goal dress size, weight of measurement?

How often do you eat?

3 Meals or less

At least 3 meals & snacks

Variety of the above

Where did you hear about us?

What diets have you tired/used in the past?

Slimming World

Weight Watchers (WW)

Slimfast

Jenny Craig

Jane Plan

Cambridge Diet

Noom

Calorie Controlled Diet

Detox

Other

None

How often do you exercise for at least 20 minutes to be breathless or to increase your heart rate?

Never

1 - 2 times a week

3 - 4 times a week

5 - 6 times a week

7 plus a week

If you do exercise, please state your fitness routine below

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