Join Cuong Strong
Date
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Month
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Day
Year
Name
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Age
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Email
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Phone Number
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Address
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Street Address
Street Address Line 2
City
State
Zip Code
What is your goal?
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What is your current weight? What is your goal weight?
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What is holding you back from reaching your goal?
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When do you to start training for your goal?
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What inspired you to contact Cuong Strong?
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Describe your current workout routine
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Where do you currently workout?
Describe your current nutrition
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Do you have any of the following conditions? If so, please explain
heart disease
diabetes
respiratory disease
epilepsy/convulsions
orthopedic conditions
thyroid disorder
gastrointestinal disorder
other
Please explain any conditions related to your health
List all medications and/or supplements
Do you drink alcohol or use tobacco products? If so, how much?
Do you have any exercise limitations or food allergies? If so, please explain
Which plan are you most interested in?
1 on 1 Personal training & nutrition (1x/week) ($270 for the first 5 weeks then $235)
1 on 1 Personal training & nutrition (2x/week) ($490 for the first 5 weeks then $440)
Exclusive gym membership ($70 for the first month then $50/month w/ training plan)
Online training & nutrition ($270 for the first month then $235/month)
Meal coaching ($170 for the first month then $120/month)
Contest Prep ($290 for the first month then $255/month)
Red light therapy ($80-120/month)
How did you hear about Cuong Strong?
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By submitting this form I agree, I have read, understand, and answered all the above questions fully and truthfully
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