Nutritional Pre-Consultation Forms

Thank you for signing up for a nutritional consultation with me!

Before we can start, please help me by filling out the forms below.

1. Physical Activity Readiness Questionnaire (PARQ)

    First Name

    Last Name

    Address 1

    Address 2




    Email Address

    Contact Number


    Emergency Contact Details

    Activity Questions
    If you are between the ages of 15 and 69, this questionnaire will tell you if you should check with your doctor before you significantly change your physical activity patterns.

    If you are over 69 years of age and are not used to being very active, check with your doctor first.

    Common sense is your best guide when answering these questions.

    Please read carefully and answer each one honestly: Simply answer YES or NO.

    Has your doctor ever said you have a heart condition & that you should only do physical activity recommended by a doctor?

    Do you feel pain in your chest when you do physical activity?

    In the past month, have you had chest pain when you were not doing physical activity?

    Do you lose balance because of dizziness or do you ever lose consciousness?

    Do you have a bone or joint problem (e.g. back, knee or hip) that could be made worse by a change in your physical activity?

    Is your doctor currently prescribing medication for your blood pressure or heart condition?

    Do you know of any other reason why you should not do physical activity?

    If you have answered Yes to any of the questions, please tell me more:

    Client Signature
    (use your cursor to sign in the space below)

    2. Agreement Form

    1. Payments Options – Can be made via PayPal, Bank Transfer & Cash.
    2. Payment Terms – Payments for Block Bookings, individually paid sessions and Nutrition Packages must be made with cleared funds prior to 1st session/ consultation being given. There are no credit term options available.
    3. Single Session Bookings (Personal Training only) – You must pay in advance for the session ahead as well as the one you are receiving.
    4. Block Bookings & Nutrition Packages – All fees must be paid in full before the 1st session/ consultation is delivered.
    5. Changes In Fees – I will notify you normally with 1 months’ notice if there are any changes in my fees, this will not affect sessions or Nutrition Packages that you have already paid for.
    6. Making a Booking – Bookings can be made via email, text, or by calling me – Please note that session and Nutrition Consultation times are on a 1st come, 1st served basis.
    7. Cancelling Sessions and Nutrition Consultation Appointments / Refunds – Must be received at least 24 hours in advance, please wait for acknowledgment for confirmation that I have received the cancellation request. If 24 hours’ notice has not been made, then the session fee will be charged. For block bookings and Consultations as part of a Nutrition Package, the session / consultation will be lost. One payment has been made there are no refunds.
    8. Client Lateness – If the client is 15 minutes late then the session / consultation will be forfeited and will be  charged for that session / consultation.
    9. My Flexibility for Clients – Please understand that I will try to accommodate all requests for a change of training times etc. but can never guarantee it. Please help me to help all of my clients by being flexible in your training times should I need to accommodate changes.
    10. Changes to this Agreement – I may change the conditions to this agreement. I will tell you if this is the case with one month’s notice in most cases.

    By signing this agreement, both Hanna Raymond & the client agree to all points detailed above.

      Client Signature
      (please use your cursor to sign in the space below)

      3. Food Diary

      Please keep a detailed record of everything that you consume within a 24-hour period over 3 days. This should capture everything, so not only your meals but all snacks/nibbles of any description. Please also include all drinks (including alcohol), butter, jam, cook-in sauces etc. plus milk in tea, coffee and cereals. Don’t forget to include any meals out, takeaways/fast-food.

      I’ve included further details and instructions on the form which you can download here in various formats:

      Once you’ve filled it out, please send it back to me via email:

      4. Nutritional and Exercise Analysis:

        Full Name

        Email Address

        Contact Number


        Describe your goals ( in order of importance) e.g. weight loss, build strength/size, improve fitness, specific sports based, improve lifestyle, other:

        Is there anything preventing you from achieving these goals?

        Previous diets/eating plans tried (if any) and results

        Please list below a typical day’s food and drink intake.


        Morning Snack


        Afternoon Snack


        Evening Snack

        Weekly alcohol consumption

        Does your eating vary much over the week?

        Current supplements (please list all)

        Particular food likes/cravings?

        Particular food dislikes?

        Allergies / intolerances (please list all)


        include: how many times a week / type of exercise / intensity