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Molded By Mia Online Training
Thank you for your interest in my online training program! Filling out this form will help me understand your fitness goals and needs!
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1
Name
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First Name
Last Name
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2
Date of birth
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Date
Year
Month
Day
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3
Email
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example@example.com
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4
Phone Number
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Please enter a valid phone number.
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5
What do you do for a living?
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6
What is your work schedule?
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Include days of the week and time of day.
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7
What is your instagram handle?
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Example: @moldedbymiaa
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8
Tell me about struggles you deal with regarding your fitness journey, physical health, and/or mental health?
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9
What goals/success would you like to see in your fitness journey?
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10
Why do you want to achieve these things? What would it mean to you?
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11
What has stopped you in the past from seeing success in your fitness journey?
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12
What are you willing to do to see success in your fitness journey?
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13
Do you have any medical conditions, injuries, or concerns that impact your health or physical capabilities?
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14
Do you have a gym membership?
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YES
NO
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15
If yes, what gym? If no, what gym would you like to join?
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gym membership and or apartment gym is required for online training. If you do not have a gym home, I will help you find one!
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16
This program requires clients to workout 4 times a week for 1 hour. Can you accomplish this?
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YES
NO
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17
This program requires at least 6 months of training. Would you be willing to stay in the program?
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It will take time to reach your fitness goals. I am looking for clients who are willing to put the work in!
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18
Online training requires self accountability and hard work. With my guidance, could you do what is required of you?
*
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Examples: Completing required workouts, implementing lifestyle strategies I encourage, showing up for zoom calls..
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NO
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19
Personal Training is an investment. Can you invest $300 per month into your fitness journey?
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I do offer payment plans!
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20
Which payment option would you prefer?
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$300 per month
$150 Bi-weekly
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21
Do you have any questions, comments, or concerns?
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