Book a ConsultationThis information is sent in the strictest confidence directly to Dan. We require all potential clients for our 1-2-1 coaching (online and in London) to fill out this form. Dan will get in touch within 72 hours of submission. Name First Last Date of birthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email OccupationMobile numberHeightWeightEmergency contact name & mobile How did you hear of the Dan Roberts Group* A personal recommendation TV / Radio / Newspaper Interview Public event / Talk Google Instagram / Twitter (@teamdanroberts) The Methodology X™ brand The Nuk SOO™ brand Dan's Linkedin (@danrobertspt) Other What injuries do you have?Do you suffer from any of the following? ME High blood pressure Low blood pressure Diabetes Disordered eating BDD ADHD Raised cholesterol Anxiety Liver or Kidney conditions Digestive problems Any heart condition Epilepsy Hernia Osteoporosis Arthritis Asthma Cramps Muscular pains Do you smoke?NoOccasionally40+ a weekHow much do you drink?Occasionally10+ units most weeks25+ units most weeksWhat medications are you on? Do you have any infectious diseases?NoYesHave you been recently hospitalized?NoYesHave you recently had surgery?NoYesAre you pregnant?NoYesDo you accept our Policies.*YesPlease see link in Footer menu for our data policy and all other standard DRG policies. For insurance purposes, we can only help you if you accept these.Waiver of Liability: Please read*We assume no liability for persons injured following our exercise or nutrition advice. In addition, any Martial Arts or combat training is only available to those who waive all liability to any accidents or injury. If any medical or other conditions arise that could affect your training with us, you shall let us know immediately by email. If you have any doubts, please consult your doctor prior to physical activity. All exercise, nutritional and well-being advice given to you by any persons directly associated with Dan Roberts, Dan Roberts Training Ltd & Dan Roberts Enterprises Ltd is taken at your own risk. By reading this you agree by these terms and our safe data policy. This is mandatory before we can meet with you.|Please read and sign aboveDid you read and accept the end of the liability waiver above?* Yes Which of your goals can we potentially help you with?What triggered you to contact us now, not last week or last month?What other fitness and wellbeing goals do you have?Why are these goals important to you?What training do you currently do?If you would like us to contact your last trainer, please give details.What are your expectations?Which exercises/activities do you love doing and why?Do you want help with nutrition?No thank youMaybeDefinitelyDo you want help with stress?No thank youMaybeDefinitelyDo you want help with body image?No thank youMaybeDefinitelyWhich activities interest you? Weight Lifting Olympic lifting TRX Body weight movements Cross Fit Ballet / Dance Boxing MMA / Martial Arts Stunts & Fight Choreography & Weapons Yoga Pilates Meditation FST & Mobility Sprinting Long distance running or cycling Competetive Sports Speed, Agility & Reaction Training Is there anything you would like to share?Do you know what coach you want? Dan Roberts: £200 ph Senior Coach/Specialist: £150 ph Coach: £125 ph Yes, a specific mix of coaches I don't mind. Up to you! How often do you want to train with us? I want a very intensive programme 5 x per week 4 x per week 3 x per week I don't know / up to you Are you interested in any of our specialist services? Regular Personal Training Strength & Conditioning for Pro Athletes Movie Role Preparation Fashion Model Conditioning Executive Training 100 Day Plan Miami Retreats International: We travel to you Bespoke Online Coaching: (starting at £1500 per month) 16 Week Post Natal Reboot (online) NUK SOO™ / Methodology X™ Where are your preferred coaching locations (London) Your Home or Royal Park (Zones 1-2) The Kensington Studio, High Street Kensington Ham Yard Hotel, Piccadilly Shangri-La Hotel, At The Shard (GUESTS ONLY) The Athletics Track, Battersea Park Do you know anyone else who would be interested in working with us?What is your availability to train?When would you like to have your face-to-face consultation with Dan?These are held at The Groucho Club, Soho. (London) Telephone/ Skype consultations are available to our international clientele.Do you have any specific additional questions for Dan?
