Fitness Coaching

Name

First NameLast Name

Birth Date

MonthDayYear

FemaleMale

Height

cm

Weight

kg

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Do you have any diagnosed health problems?

Are you taking any medications? If yes, please list below.

Do you have any injuries? If yes, please list below.

YesNo

What is your daily activity level?

1 is None, 5 is High

What is your daily stress level?

1 is Low, 5 is High

Please rate your readiness to change.

1 is Worst, 5 is Best

Signature

Date

My Products

1-1 In Person PT Session

Personal Training Session

$45.00 Quantity

Fitness Analysis

-Discuss goals -Learn current lifestyle and daily routine -Plan 12 week minimum transformation -Log measurements -Body fat measurement -Establish BMR vs TEE to meet calories in vs calories out quantitative goal -Weekly checkin

$85.00

Group Fitness Session

$20.00

Online Intro Session

-Discuss goals -Discuss current lifestyle and daily routine -Plan 12 week minimum transformation -Log measurements -Establish BMR vs TEE to meet calories in vs calories out quantitative goal -Weekly checkin

$30.00

Venmo Payment

Enter @Mitchell-Bennett-17 into Venmo search to find my account and make payment or scan QR

$ Free

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Your Information