Let’s get in shape!!!
Fitness assessment is free :)
Full Name
First Name
Last Name
Cell number
*
Age
years
Height
In
Weight
LB
Goal weight
Have you trained with a personal trainer before?
Yes
No
What kind of training did you do?
What is your current level of physical activity?
What type of exercise are you doing now (check all that apply)
None
Classes
Treadmill/elliptical/bike
Weight machines
Swimming
Walking
Other
Are you pregnant?
Yes
No
If you have any injuries, diagnosed health conditions, pelvic floor or muscle issues, please list them.
Which of the following best describes your goals?
Improved health
Weight loss
Get stronger
Generally get into shape
What does success in fitness and health look like to you?
What are the biggest obstacles that have kept you from reaching this goal in the past? (It can be anything - time, money, knowledge, motivation etc)
What are you hoping that I can help you with the most?
How many times per week can you work out?
I’M READY FOR MY FREE FITNESS ASSESSMENT!!!
Yes
YES!
A MILLON PERCENT YES!!! LET’S GOOOO!!!
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