//How do you want to get fit and healthy

How do you want to get fit and healthy

self online

 

Please fill in the form below and email it to info@selfonline.co.uk get a friend to fill it in and you can both benefit from a FREE Personal Training session at self… as a thank you !

 

Clik here to down load the form –  How do you like to get fit and healthy

 

 

 

Have you heard of “Self Holistic Health”?

 

 

 

 

 

 

What does the name communicate to you?

 

 

 

 

 

 

 

 

What are your current health and fitness goals or interests?

 

 

 

 

 

 

                                                       

Do you have any current health related issues or fitness challenges?

 

 

 

 

 

 

Are you aware of and/or interested in any of the following services at Self Holistic Health?

 

 

Aware of?

 

Interested in?

Currently involved in/attend?

Diet, nutrition and lifestyle programs

Yes       No

Yes       No

Yes       No

Sports/injury massage

Yes       No

Yes       No

Yes       No

Holistic personal training

Yes       No

Yes       No

Yes       No

Pilates

Yes       No

Yes       No

Yes       No

Yoga

Yes       No

Yes       No

Yes       No

Stress management

Yes       No

Yes       No

Yes       No

Body transformation

Yes       No

Yes       No

Yes       No

Back care

Yes       No

Yes       No

Yes       No

Personal training 1 on 1

Yes       No

Yes       No

Yes       No

Personal training in a small group

Yes       No

Yes       No

Yes       No

Nutrition lifestyle course

Yes       No

Yes       No

Yes       No

Meditation

Yes       No

Yes       No

Yes       No

Cancer prevention programs

Yes       No

Yes       No

Yes       No

Health Assessment

Yes       No

Yes       No

Yes       No

 

 

What is your greatest challenge to achieve your goals?

 

 

 

 

 

 

Would you like us to contact you regarding how we can help you achieve your health and fitness goals?

Yes                    No          

 

Would you like a FREE PT session?

Yes                     No          

 

If yes please provide us with your name and email:

 

Name:

 

 

 

Email:

 

 

 

 

 

Please email to info@selfonline.co.uk 

 

Thank you 

2015-02-25T16:52:15+00:00

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