Program Application Form
Great, congrats on making it this far! Now, let's get some information from you to figure out where you are, where you can be, and where you want to be! It'll also help us decide together what the best program / package combo is for you, your needs and lifestyle.
Basic Information
Full name
*
Date of Birth
*
Please select a year
2024
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Year
Please select a month
Janvier
Février
Mars
Avril
Mai
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Month
Please select a day
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Day
Phone Number
*
123-456-7890
E-mail
*
myname@example.com
Residence Location / Timezone
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Health History
Do you have any health issues and/or pains that you believe might hinder or limit the kind of training and exercises you can do? (There is no right or wrong answer here. You need to be very candid for your own health and wellbeing)
What is your current height?
*
in centimeters (cm) or inches (in)
*
Centimeters (cm)
Inches (in)
What is your current weight?
*
in kilograms (kg) or pounds (lbs)
*
Kilograms (kg)
Pounds (Lbs)
Do you have any dietary restrictions?
Vegetarian
Vegan
Kosher
Lactose Intolerant
Gluten Intolerant
NONE
Other
Health & Fitness Goals
What are your health and/or fitness goals (choose all that apply)
*
Gain Strength
Get Toned
Lose Body Fat
Gain Weight
Fix My Posture
Get Pregnant
Lose the Pregnancy Weight
Have a Healthy Active Pregnancy
I just need something to help me let-off some steam! GIVE ME A PUNCHING BAG!
I JUST WANT TO FIT INTO THIS DANG WEDDING DRESS!
Other
How did you hear about TRIMPOSSIBLE FITNESS and/or Coach Mona?
*
Friend Referral
Social Media - Instagram
Social Media - Facebook
Other
Which TRIMPOSSIBLE FITNESS program do YOU think is best for you? (This is not final, we will still be discussing what program is best for you together later on)
*
TRIMPOSSIBLE for Chicas
TRIMPOSSIBLE for Preggo Chicas
TRIMPOSSIBLE for Mommas
Not sure
How do you think a Trimpossible Fitness program can help you?
*
Are you willing to invest USD200 - USD600 per month in your health and fitness?
Yes, I am!
No, I'm not..
Fitness History
How would you describe your previous training/personal-training experience
*
I'm a pro athlete. Arnold Schwarzennegger aint got nothin' on me!
I've been training regularly for years. I am one with the gym!
I've been training on & off for years, fitness and I have a complicated relationship
I've trained a bit here & there and tried different things, but nothing ever stuck
I have no idea what I'm doing and weights scare me!... HELP!
If you have worked with a personal trainer and/or nutrition coach before, what was your experience?
Have you ever tried any of the following programs/routines? (select all that apply)
*
Crossfit
Insanity
P90X
Beach Body
DDP Yoga
PIIT28
BBG
P.Volve
NONE
Other
Please list the ones that HAVE worked for you, if any (feel free to explain why)
More About YOU
If you never had to worry about calories, health, weight, nutrition...etc., what food/drink would you eat/drink every day?
*
What is your favorite movie/show?
*
Which one are you?
*
Extrovert (I love being around people!)
Extreme Extrovert (If I'm not around people for more than a day I'd go crazy!)
Introvert (I would rather spend time with myself and/or alone with someone I like)
Extreme Introvert (I hate being around people!)
Neither or somewhere in between
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