Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Weight
KG
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?
Yes
No
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
if yes please list:
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained before. If yes what kind of training did you do:
What are the timings that suit you?
6-7am
7-8 am
5-6 pm
8-9 pm
Other
What is your specific goal
Fat loss
Weight gain
enhance performance
Other
How often are you willing to train a week to reach your goal?
3 times
4 times
5 times
Are you willing to do what it takes for a better change !?
Yes
No
Maybe
Are you willing fight temptation and see better results
Yes
No
Are you ready to make this change count !?
Yes
No
Shall we do this
Hell yeaaah
No
Submit
Should be Empty: