Private Programming
Commit to Be Fit with Ms. Dee Fit!
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Age
Gender
Female
Male
Prefer not to answer
Other
Do you have any medical conditions or injuries?
Yes
No
Please give details
Current weight/Goal weight
Current height
How many days per week do you plan to exercise?
1 Day
2 Days
3 Days
4 Days
5 Days
6 Days
Everyday
How many hours per day do you plan to exercise?
1 Hour
1-2 Hour
2-4 Hour
4-6 Hour
More than 6 hour
What program are you interested in
Active/Intermediate
Athlete/Competitive- Advanced
Wellness- Beginner
Which program are you interested in?
3-day
5-day
7-day
7+
Virtual sessions
Other
Are you interested in
At home workouts
In person
Group classes
Virtual classes
Personal Training in person/virtual
Please list the goals according to your priority. (First 3 option will be prioritized.)
If you have a fitness routine right now, please explain it.
If you have any exercise history, please explain the routine, your motivation, obstacles, etc.
How motivated are you to change your life by investing your time, money and hard work?
1
2
3
4
5
Not much
Very
1 is Not much, 5 is Very
START!
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