New Client Application V2

Age* This field is required.

20-30

30-40

40-45

46-50

50-55

56-60

60+

Sex* This field is required.

Male

Female

Height* This field is required.

Under 5'0

5'0"

5'1"

5'2"

5'3"

5'4"

5'5"

5'6"

5'7"

5'8"

5'9"

5'10"

5'11"

6'0"

6'1"

6'2"

6'3"

6'4"

6'5"

Above 6'5"

Weight (Pounds)* This field is required.

Under 100

100-110

111-120

121-130

131-140

141-150

151-160

161-170

171-180

181-190

191-200

201-210

211-220

221-230

231-240

241-250

251-260

261-270

271-280

281-290

291-300

301-325

326-350

350-400

400+

Do You Have Any Injuries?* This field is required.

Neck

Low back

Shoulder

Knee

Elbow

Ankle

Hip

Wrist

Mid back

Other

None

Any Previous Surgeries?* This field is required.

Neck

Low back

Shoulder

Elbow

Knee

Hip

Ankle

Foot

Adbominal

Heart

Brain

Wrist

Other

None

Do You Have Any Medical Conditions* This field is required.

High blood pressure

Type 1 diabetes

Type 2 diabetes

Cancer

Autoimmune disease

Asthma

Other

None

Are You On Any Medication That Would Affect Exercise/Weight Loss?* This field is required.

High blood pressure

Diabetes/blood sugar

Cholesterol

Antidepressants

Other

C'mon Blaine I'll Tell You Later

None

Do You Have Clearance From Your Doctor To Start An Exercise And Diet Program?* This field is required.

Yes

No, but I'll get it asap!

Occupation* This field is required.

Professional

Business owner

Retired

Other

None

How Much Weight Do You Want To Lose (Pounds)?* This field is required.

10-20

21-50

51-75

76-100

101-150

151+

I'm lucky I don't need to lose any weight

What Are Your Goals?* This field is required.

Weight loss

Better health markers

Feel better

More energy

Better sleep

Stress management

More confidence

Other

What's Stopping You From Reaching Your Goals On Your Own?* This field is required.

Don't know what to do

No time

No energy

Always hungry/cravings

No motivation

No willpower

Need accountability

Need support

I'm outta control! Help!

Other

What Else Have You Tried To Lose Weight?* This field is required.

Personal trainer

Weight Watchers

Zumba

Orange Theory

Spin classes

Yoga

Weight loss supplements

Online trainer

Fit Body

Keto

Fasting

Vegetarian

Cardio

Praying

Group classes

Other

None

How Did You Hear About Me?* This field is required.

Facebook

Google

Instagram

Radio

Billboard

Client Referral

Mail

Business/Professional Referral

Youtube

Tradeshow

Wellnessnews

Other

What Would You Say Your Weight Training Experience Is?* This field is required.

Beginner

Intermediate

Advanced

What Would Be The Most Important Criteria For Success If We Work Together?* This field is required.

Weight loss

More energy

Better health markers(blood pressure, blood sugars, etc.)

Better sleep

Improved self confidence

Stress management

Be able to function better for activities for daily living

Other

On A Scale Of 1-10. 1 Being I'm Satisfied Where I Am And 10 Being I'll Do Anything To Reach My Goal What Number Are You?* This field is required.

What Would You Expect From Us As Your Coaches If We Were To Work Together?* This field is required.

Accountability

Support

Proper Guidance

Availability to ask questions

Motivation

Other

I Understand That Results Are Not Guaranteed And What I Put In Will Largely Dictate My Results.* This field is required.

Yes, I understand

No, I don't understand

I Understand That Any Type Of Exercise Program Does Carry An Element Of Risk However Small It May Be And That I Will Not Hold Anyone Responsible Should Any Instance Occur.* This field is required.

Yes, I understand

No, I don't understand

If Accepted How Soon Are You Looking To Get Started?* This field is required.

Yesterday

In the next week

In the next month

In the next 3 months

In the next 6 months

I have no idea I'm just checking things out

If We Work Together And You Have Not Only Reached Your Goals, But We Have OVERDELIVERED On Everything We Have Promised Are You Able To Refer 2 People Of Equal Stature As Yourself That May Need Our Services?* This field is required.

Yes

If We Are A Good Fit And I Feel I Can Help You Are You Willing To Put In A Solid Effort, Follow The Program, And Train Together For At Least 12 Weeks?* This field is required.

Yes

If You Are Happy With The Results And Our Services How Long Do You Plan On Staying With Us For?* This field is required.

3 Months

6 Months

1 Year +

Forever

Until I reach my goals

I Understand This Is A 4 Week At A Time Membership That I Will Be Charged Whether I Make It To All Or None Of My Sessions. I Am Paying To Hold My Spot, Ongoing Support, Education, And Gym Fee. These Charges Are Recurring Until I Cancel, Which I Can Do At Anytime.(For Training In The Gym)* This field is required.

Yes, I understand

No, I don't understand

Do You Want To Train Online Or In Person (In Winnipeg)?* This field is required.

In person

Online 12 Week Program $1997

What Type Of 4 Week Gym/Training Membership Are You Interested In?* This field is required.

Train 2x/Week $597

Train 3x/Week $847

Are You Willing To Use A Credit Card For The Membership?* This field is required.

Yes

Are You Comfortably Able To Afford $5000 To Invest In Yourself, Your Health, And The Way You Feel About Yourself WITHOUT It Negatively Affecting Other Essential Areas Of Your Life?* This field is required.

Yes, I can comfortably afford $5000 without it negatively affecting me, my life, or that of my family.

No, spending $5000 on your service will be difficult for me and may negatively affect that of me or my family.

Training Times Flexibility. Are You Flexible With When/What Times You Train?* This field is required.

Yes

Somewhat

What Time Of Day Do You Want To Workout?* This field is required.

6am-7am

7am-8am

8am-9am

9am-10am

10am-11am

11am-12pm

12pm-1pm

1pm-2pm

2pm-3pm

3pm-4pm

4pm-5pm

5pm-6pm

6pm-7pm

7pm-8pm

8pm-9pm

Doesn't Matter

Do You Want To Train On Saturdays 8am-3pm?* This field is required.

Yes

I Understand That If I Book A Time That I Only Have An Hour And That If I Show Up Late My Workout Will Be Cut Short.* This field is required.

Yes, I understand

No, I don't understand

I Understand That If I Cancel An Appointment Last Second I Can Try To Rebook At Another Time That Week If There Is Anything Open.* This field is required.

Yes, I understand

No, I don't understand

Why Do You Think You Would Be A Good Addition To Our Program?* This field is required.

Out Of All The Options Out There What Is The Reason You Decided To Contact Us/Possibly Want To Work With Us?* This field is required.

I Understand That If I Join The Gym The Trainers Who I Work With Can Vary From Session To Session.

Yes, I understand

No, I don't understand

I Understand That If The Phone Consult Goes Well I Will Get To Try Out The Gym Before I Make Any Kind Of Financial Commitment. This Way I Can Relax On The Phone Consult And Not Be Worried About Any "Hard Sells."

Yes, I understand

No, I don't understand

Name* This field is required.

First Name

Last Name

Email* This field is required.

example@example.com

Phone Number. (This is your last question. Once you hit "submit" you will be redirected to a scheduling page to book a day and time for a phone call. PLEASE DO THIS AS WE NEED TO DO A PHONE CALL TO PROCEED.)* This field is required.

Area Code

Phone Number

Please verify that you are human* This field is required.