1-1 application

Name*

First NameLast Name

How old are you?*

Email*

example@example.com

How did you hear about my services?*

What is your height? (feet, inches)*

What is your weight? (in pounds)*

What is your most important fitness goal right now?*

What are you currently doing to work on this goal?*

How many days a week are you currently working out? Honest please :)*

What is your biggest struggle and how is it holding you back?*

How many days a week can you realistically dedicate to your goals?*

Are you on any medications?*

Current or past injuries? Please explain. *

Depending on your answers above, a physician's clearance may be necessary. Are you willing to obtain that?*

Training home or gym? If home, what equipment do you have available?*

How many steps a day do you average?*

List out a typical day of foods and when, as honest as possible please.*

Do you fall off track on the weekends?*

How often do you eat out per week?*

What do you do for work?*

How active is your job? (sitting, standing, physical, etc)*

What are your short term goals? (6-8 weeks)*

What are your long term goals? (6-12 months)*

Why do you want to start now? Why are you ready to make these changes in your health and fitness?*

How committed are you to reaching your goals?*

What is your expectation working together?*

Learning how to build a new lifestyle to reach these goals takes TIME and ENERGY. This is a 1-1 program created just for you and your goals. Are you 100% committed to achieve your fitness goals?*

Yes! I am 100% ready and committedI have a strong desire to reach my goals and will try my bestI'm not ready for this commitment just yet.

Please fill out the complete application