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West Northants Pickleball
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Let's Get Started

Welcome! You've taken the first step toward a healthier you, and I'm so glad you're here. To make sure our first conversation is as helpful and productive as possible, please take a moment to fill out this form. The information you provide will help me understand your goals and ensure we can find the perfect service to support your journey.

I'm here to support you...

Your Personal Details

First name*

Last name*

Phone*

Address*

Birthday*

Day

Month

Year

Email*

Gender*

Male

Female

Other

Prefer not to say

Your Health Goals

Height (cm or ft)*

Weight (kg, st or lbs)*

Current BMI (if known)

Brief Medical Summary*

Please provide any relevant medical history or conditions (e.g., knee pain, high blood pressure, type 2 diabetes) that we should be aware of to ensure your safety and adapt the programme for you.

Which services are you interested in? (You may select more than one.)*

PowerPlay Pickleball

Bespoke Personal Training

Movement & Mindset Coaching

Nutrition Guidance & Accountability

Longevity & Mobility Coaching

Pickleball Coaching

Integrated Health & Fitness Package (The ultimate package combining Bespoke Personal Training, Movement & Mindset Coaching, and Nutrition Guidance)

What motivated you to connect with us?*

Please tell us what inspired you to start this journey.

What are you hoping to achieve?*

Examples: increase my fitness, lose weight, meet new people, manage a chronic condition, improve my mental health, etc.

Consent for Health Checks

I consent to participating in regular health check updates (e.g., blood pressure, height, and weight readings) throughout the programme. I understand this data will be used to track my progress and will remain confidential.

Your Current Activity Levels

On average, how many hours of moderate-intensity physical activity (e.g., brisk walking, cycling, gardening) do you do per week?

On average, how many hours of vigorous-intensity physical activity (e.g., running, intense aerobics, competitive sports) do you do per week?

What is your general availability like?*

Consent and Submission

I consent to West Northamptonshire Pickleball CIC contacting me about the PowerPlay Pickleball programme. By submitting this form, I confirm that the information I have provided is accurate to the best of my knowledge.

West Northamptonshire Pickleball CIC

Bragborough Hall Business Centre,

Welton Road,

Daventry,

NN11 7JG.

07516 689202

kate@westnorthantspickleball.com

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