NEW CLIENT QUESTIONNAIRE
FILL OUT THE QUESTIONNAIRE BELOW, CLICK SUBMIT & WE WILL BE IN CONTACT WITHIN 24 HOURS!
FULL NAME:
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First Name
Last Name
EMAIL:
*
example@example.com
CELL PHONE:
*
-
Area Code
Phone Number
ADDRESS: (BEST FOR SHIPPING)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SEX:
*
MALE
FEMALE
AGE:
*
CURRENT BODY WEIGHT:
*
DESIRED BODY WEIGHT:
*
CURRENT BODY FAT % (USE PICS ABOVE):
*
DESIRED BODY FAT % (USE PICS ABOVE):
*
CURRENT ACTIVITY LEVEL:
*
SEDENTARY (I'm currently not active)
LIGHT (1 - 2 days per week)
MODERATE (2 - 3 days per week)
VERY ACTIVE (3 - 5 days per week)
I"M ACTIVE EVERY DAY
WORKOUT EXPERIENCE:
*
(0 - 1 YEARS)
(1 - 3 YEARS)
(3+ YEARS)
CURRENT GYM SET-UP:
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COMMERCIAL GYM (LA, 24 FITNESS ETC...)
AT HOME (I HAVE A DESIGNATED WORKOUT SPACE)
AT HOME (I MAY NEED HELP SETTING UP MY SPACE)
OFFICE/APARTMENT GYM
I DON'T KNOW & NEED HELP FINDING A GOOD FIT
WHAT BEST DESCRIBES YOUR GOALS?:
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I WANT TO LOSE 5 - 25 LBS & LEAN UP
I AM SKINNY & WANT TO GAIN SIZE & STRENGTH
I AM OVERWEIGHT & WANT TO LOSE 50 - 100+ LBS
I AM ALREADY LEAN & WANT TO GET LEANER
WHAT DESCRIBES YOUR NATURAL EATING RHYTHM:
*
2 MEALS + 2 SNACKS PER DAY
3 SQUARE MEALS PER DAY
MOSTLY SMALL SNACKS + 1 MEAL PER DAY
PLEASE TAKE US THROUGH A TYPICAL EATING DAY FOR YOU (OPTIONAL):
PLEASE BE HONEST! THERE IS NO JUDGEMENT! THIS IS JUST SO WE CAN HELP COACH YOU BETTER.
PLEASE LIST ANY KNOW FOOD ALLERGIES OR SENSITIVITIES?
PLEASE LIST ANY KNOW INJURIES, SURGERIES OR CHRONIC PAINS?
PLEASE LIST ANY ADDITIONAL INFORMATION THAT YOU WOULD LIKE US TO KNOW
WHAT ARE YOU MOST INTERESTED IN (CHECK ALL THAT APPLY)
*
ONLINE COACHING
PERSONAL TRAINING
SPORTS PERFORMANCE
HOME GYM DESIGN
BUSINESS CONSULTING
GENERAL ADVICE & GUIDANCE
OTHER
HOW DID YOU HEAR ABOUT US? (CHECK ALL THAT APPLY)
*
GOOGLE
SOCIAL MEDIA
REFERRAL/WORD OF MOUTH
AD (FLYER/POSTER ETC...)
OTHER
WHAT IS YOUR PREFERRED FORM OF CONTACT?
*
VIA PHONE CALL
VIA EMAIL
VIA IN-PERSON
VIA TEXT
GET READY TO JOIN THE TEAM
SUBMIT MY QUESTIONNAIRE
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