Personal Intake Survey for Annual Members

Annual Membership

Intake Survey

We are so excited that you've committed to a whole year of PoleSphere - and we can't wait to help you smash your goals! As an annual member you are now entitled to exclusive small-group online coaching sessions, tailored wellness information unique to you and regular check-ins to keep you on track...

Hello
Please complete your personal intake form below:

- Step 1 of 5

Your Account

Please enter your name & email as per your PoleSphere account (or simply log in first, then return to this form and we'll take care of the rest!)

Name *

First

Last

Email *

Confirm Email

Your Skills & Experience

How long have you been doing pole in total? (NOT including long breaks) *

(in years and/or months)

If you had a long break, how long have you been back at it for? *

(in years and/or months)

Which (if any) of the following moves can you confidently perform?

Basic Invert
Inverted Straddle (from floor)
Aerial Straddle
Shoulder Mount
Extended Butterfly
Split Grip Ayesha
Brass Monkey
Iron X
Deadlift

Your Style & Preferences

Number these styles of pole class from your most favourite (1) to your least favourite (5)

Tricks only class *

Conditioning class *

Heels choreography class *

Barefoot Choreography class *

A mixed Tricks/Choreography class *

Which PoleSphere teacher do you think most closely represents your personal pole style and why? *

Adam Lin
Andrea James Lui
Carlie Hunter
Chilli Rox
Guest Instructor
Joanna Littlewood-Johnson
Lisa D
Lola Grace
Megan B
Miss Filly
Mucci
Suwasit
Suzie Q
Suzie Q and Toby J
Tammy

Why? *

Your Goals

What are your 3 month POLE goals? *

What are your 1 year POLE goals? *

What are your 3 month HEALTH/WELLNESS goals? *

What are your 1 year HEALTH/WELLNESS goals? *

Your Health & Wellness

On a scale of 1 - 10 how would you rate your understanding of the following:
(1 being lowest, 10 being highest)

Understanding how your eating habits affect you physically and mentally?

Selected Value: 1

Understanding what a general healthy diet consists of?

Selected Value: 1

Understanding how to eat appropriately to maximise energy and optimise recovery from training?

Selected Value: 1

How much water do you drink in a day? *

What other beverages do you drink on a daily basis, and approximately how much? *

On a scale of 1 - 10, how would you rate your current energy levels:
(1 being lowest, 10 being highest)

In the morning *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

In the early afternoon *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

In the late afternoon *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

In the evening *

Rate 1 out of 10Rate 2 out of 10Rate 3 out of 10Rate 4 out of 10Rate 5 out of 10Rate 6 out of 10Rate 7 out of 10Rate 8 out of 10Rate 9 out of 10Rate 10 out of 10

On average, how much sleep do you get per night? *

Less than 5 hours
5-6 hours
6-7 hours
7-8 hours
8-9 hours
More than 9 hours

Does it regularly take you more than 20 minutes to get to sleep once in bed at night? *

Yes, it does
No, not usually

Do you wake regularly through the night? *

Do you wake in the morning feeling refreshed? *

Yes, I usually do
No, not normally

On a scale of 1 - 10, how PHYSICALLY stressful would you rate your day to day life?

Selected Value: 1

On a scale of 1 - 10, how MENTALLY stressful would you rate your day to day life?

Selected Value: 1

Do you feel you have a good work/life balance? *

Yes, mostly
No, not really
Not sure

Do you feel you put excessive amounts of pressure on yourself? *

Yes, frequently
Yes, occasionally
Never, or almost never

Thank you for sharing all that with us!

Last but not least...

Your Availability

As an annual member you are entitled to exclusive coaching, accountability and personalised check-ins (to keep you on track with all your goals!)

What day/time would you be available to join a small group coaching session? (choose all that apply) *

Weekdays early morning, to finish before 9am
Weekdays between 9am -12pm
Weekdays between 12pm -3pm
Weekdays between 3pm - 7pm
Weekends

ALL TIMES LISTED IN AEST (AUSTRALIAN TIME)

Website

PLEASE NOTE:

Your intake questions are broken up into the following categories:
- Your Skills & Experience
- Your Style & Preferences
- Your Health & Wellness
- Your Goals
- Your Availability

We expect this survey to take between 10 and 30 minutes to complete. Please allow enough time for all questions as you will not be able to save your progress.

Thank you!

Annual Membership

Intake Survey

Hello
Please complete your personal intake form below:

Your Account

Your Skills & Experience

Your Style & Preferences

Your Goals

Your Health & Wellness

Your Availability

HOME

LIBRARY

EMPORIUM

MEMBERS LOUNGE

COURSES

& MORE

HOME

LIBRARY

EMPORIUM

Annual Membership

Intake Survey

Hello Please complete your personal intake form below:

Your Account

Your Skills & Experience

Your Style & Preferences

Your Goals

Your Health & Wellness

Your Availability

HOME

LIBRARY

EMPORIUM

MEMBERS LOUNGE

COURSES

& MORE

HOME

LIBRARY

EMPORIUM

Hello
Please complete your personal intake form below: