Conneally Wellness - Coaching Interest Form

Mobility Sessions • 1:1 Coaching • Semi Private Group Training

Thank you for your interest in The Conneally Wellness Project.

Please fill in this short form so I can complete a pre-assessment and reach out with the next steps

Section 1: Contact Information

Your First Name: *

Your Last Name: *

Your Date of Birth: *

Your Email Address: *

Your Mobile Number: *

What county are you living in? *

Section 2: Your Current Status & Goals

How would you describe your current activity level? *

Little to no exercise, mostly sitting, occasional walks

Walking the dog, Farming or gardening, occasional activity

Regular Walking, Weekend Golf or Cycling, Manual work

Active sportsman, running, cycling or gym multiple times/week

Please state your Occupation *

(This helps us gauge daily activity levels, travel hours, social events etc.)

Which service are you most interested in? *

1:1 Personal Training

Semi-Private Group Training

Mobility & Recovery Classes

Online / Distance Coaching (Hybrid)

(Select all that apply above)

What is your primary training goal at the moment? *

What’s your main motivation right now? *