Book Now – Simuka Wellness

Name

First

Last

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Email

Phone

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What is your current age?

Gender

How would you describe your current activity level

Sedentary
Lightly active
Moderately active
Very active

Do you have any medical conditions or physical limitations we should be aware of (e.g., hypertension, diabetes, joint issues)?

How important is nutrition guidance to you (e.g., meal planning, nutrition coaching, balancing)?

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How often do you want to work out per week?

What is your current diet like (e.g., high protein, processed foods, typical Zimbabwean diet, healthy eating)?

Do you have any specific fitness goals related to:

Joints fitness (e.g., improving flexibility, reducing pain)
Strength and muscle (e.g., building muscle mass, increasing strength)
Golf fitness (e.g., improving swing, increasing endurance)
Sleep (e.g., improving sleep quality, duration)
Mental health (e.g., reducing stress, improving mood)
Metabolic health (e.g., managing hypertension, diabetes, fat loss)

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Have you worked with a personal trainer or fitness coach before, was it successful or not ?

How did you hear about our fitness program?

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Are you willing to commit to a minimum of 3-6 months of training?

Yes
No

Do you struggle with sleep or experience any sleep-related disorders?

Yes
No

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Do you experience any menopausal symptoms, such as hot flashes, night sweats, or mood changes?

Yes
No

Do you feel a need to improve your sexual health and function ?

Yes
No

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What motivates you to start a fitness program, and how can we support you in staying accountable?

How important is stress management to you, and do you have any specific stress-reducing activities or techniques you'd like to incorporate into your fitness program?

Questions for us?