Please complete this consultation as fully as possible. It takes around 10–15 minutes and helps Angelina build a programme around you. Fields marked * are required.

Personal details

Full name

Date of birth

Sex Used to set protein and calorie targets.

Email address

Mobile number Your WhatsApp support line will be set up on this number.

PostcodeHelps us plan in-person sessions in Salford.

Height

Current body weight

Occupation

Preferred method of contact

Which plan are you interested in?

Have you had your medical consultation with Dr Rafie yet?

How did you hear about the programme?

Goals & motivation

What is your main goal, and what would you like to achieve from working with us?

Why is achieving this goal important to you right now?

Have you tried to achieve this goal before? If so, what worked well and what did you struggle with?

Do you have a target weight or measurement in mind?

Food & nutrition

Do you have any food allergies or intolerances? If yes, please list them.

Please list any foods you dislike or would prefer not to include in your plan.

Please list some of your favourite foods.

Are there any specific foods or meals you would like included in your plan?

What does a typical day of eating currently look like? Please include meals, snacks and drinks where possible.

How many meals per day would you ideally like your nutrition plan to include?

How much time are you willing or able to spend preparing food, and how confident are you with cooking?

Do you regularly eat out, order takeaways, or have social occasions you would like your plan to accommodate?

Do you drink alcohol? If so, roughly how often and how much?

Roughly how many caffeinated drinks do you have a day?

Do you currently take any supplements (protein, creatine, vitamins etc.)?

Lifestyle & recovery

What is your daily movement and general activity level like? For example, is your job mostly seated, active, or a mixture of both?

Do you wear a fitness watch or use a device/app that tracks your daily steps? If yes, what is your approximate average daily step count?

On average, how many hours of sleep do you get per night, and how would you rate your sleep quality?

How would you describe your current stress levels — low, moderate or high? Is there anything regularly contributing to your stress?

Do you work shifts or irregular hours?

Accountability & coaching

What do you feel you struggle with most when it comes to staying consistent with training and nutrition?

Is there anything in particular you would like from Angelina as your coach to help you stay accountable and achieve your goals?

How would you like to receive feedback from your weekly app review?Your coach reviews your progress in the app every Monday. If you’re away or need a different day in a particular week, just let us know.

Anything else

Is there anything else you feel would be useful for us to know before we start working together?

Emergency contact – nameOnly needed for in-person training sessions.

Emergency contact – phone

Please note: this consultation helps inform your coaching programme and is not a medical assessment. If you have any health concerns or have been advised to seek medical guidance before exercising, please raise them with the clinic before beginning your programme.

Weight Management Consultation Form

Weight Management Consultation Form

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