Full Name:
*
First Name
Last Name
Gender:
Male
Female
WhatsApp No:
-
Area Code
Phone Number
Insta Handle:
Date of Birth:
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
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2016
2015
2014
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2012
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1924
1923
1922
1921
1920
Year
Age:
years
Height:
cm
Weight:
KG
What do you do for a living?
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Please list the physical activities that you participate in outside of the gym and outside of work:
If you have any diagnosed health problems list the condition(s):
Please rate your readiness for change:
1
2
3
4
5
6
7
8
9
10
What of the following means the most to you?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
Why would you like to achieve this?
Timeline for achieving your goal:
Rows
8 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
How often are you willing to train a week to reach your goal?
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
If yes what kind of training did you do:
Submit
Should be Empty: