Tina Marie Fitness
WELCOME! I’m so excited to have you be part of the team. To make sure I can help you the best that I can please take a moment and fill look out this form. The information will not be shared. I look forward to working with you and working on our goals together!
Name
First Name
Last Name
Email
example@example.com
Birth Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Instagram handle(you can follow me @tina_marshall21)
On a scale of 1-10 how committed are you to reaching your goal?
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2
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10
On a scale of 1-10 how accountable do you want me to hold you towards your goals?
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2
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5
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9
10
What do you do for a living?
Have you ever tracked macros?
Yes
No
I don’t know what they are
What’s your level of daily movement?
Please Select
Not Active
Slightly Active
Moderately Active
Highly Active
What kind of exercise are you currently doing?
Walking
Weight lifting
Body weight workouts
Yoga
Crossfit
Pilates
Running
Other
How would you rate your energy level?
Please Select
Poor
Good
Great
Excellent
Your current diet could be characterized as:
Please Select
Low Fat
Low Carb
High protein
Vegetarian
Vegan
Other
How would you rate your stress level?
Please Select
Not Stressed
Slightly Stressed
Very Stressed
How many hours of sleep do you get nightly?
Please Select
Less than 6
6-8
More than 8
What are some of your health goals? Select all that apply.
More Energy
Better Sleep
Weight Loss
Stronger Hair, Skin, & Nails
Better Time Management
Better Digestion
Improved Skin Health
Better Nutrition
More Fitness/Exercise
Better Immune System
What have you struggled with in the past when it comes to reaching your fitness/nutrition goals?
Do you have any current health issues?
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