Ford Strong Fitness LLC.
Please complete the following questionnaire to assist me in tailoring a fitness program specifically for YOU!
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Help Dee get to know you!
Please, be open and honest when completing this wellness evaluation.
My goal is to:
Lose weight
Tone up/Lose belly fat
Gain lean muscle
Live a healthier lifestyle
Have more energy
Other
How much do you currently weigh? (lbs)
How tall are you? (ft/in)
What is your ideal goal weight? (lbs)
Have you ever hired a personal trainer?
Yes
No
If yes, when did you start and why did it end?
How often do you eat takeout?
Once a week, or less
Several times per week
Do you drink?
Not at all
Occasionally/Socially
On the weekends
Throughout the week
Name one food you cannot live without.
How much would you be able to spend on your wellness journey (nutrition information included)?
$270 (8 sessions completed within 4 weeks)
$370 (12 sessions completed within 4 weeks)
$470 (16 sessions completed within 4 weeks)
Personalized macro based meal plans with nutrition coaching are available.
*
No specified meal plan needed.
Specified meal plan (extra fee)
How experiences are you with using gym equipment?
Beginner
Experienced
Very experienced
How soon would you like to start?
As soon as possible
Not sure yet/Need more info
Other
If other, when?
-
Month
-
Day
Year
Date
How many days per week are you looking to train?
2
3
4
What hours are you looking to personal train?
Morning
Afternoon
Evening
Do you have any current physical ailments that prohibit, or could potentially prohibit, you from engaging in physical activities? If so, please explain and be very detailed.
What is your preferred form of communication?
Phone/Text
E-mail
How did you hear about Ford Strong Fitness LLC.?
Message to your future coach!
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