Become a Client

Become a Client
Name
Age
Gender

MaleFemaleOther
How would you prefer to be contacted?

TextEmailPhone
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
How did you hear about me?
Which services are you interested in?

Personal Training (private studio)Personal Training (online)Life Coaching (in-person)Life Coaching (online)
What are your Personal Training goals? (if applicable)

Build MuscleIncrease StrengthLose WeightBuild EnduranceIncrease FlexibilityLearn how to workout safely and effectively on my own.
For Life Coaching clients, which areas of your life are you looking to improve?

CareerFamily & FriendsSignificant Other/RomanceFun & RecreationHealthMoneyPersonal GrowthPhysical Environment
For Personal Training clients, do you have any joint issues or major health problems?

YesNo
If Yes, please describe briefly.
For Personal Training clients, what kind of diet do you follow? Select all that apply.

CarnivoreVeganVegetarianPescatarianOmnivoreIntermittent fastingKetogenic/low carbOther
For Personal Training clients, are you trying to lose and/or gain weight? If so, how much?

Lose 5-10 lbsLose 10-25 lbsLose 25-50 lbsLose 50+ lbsGain 5-10 lbsGain 10-25 lbsGain 25+ lbsNot trying to lose or gain weight.
How often would you like to work with Lance?
What is your current level of motivation?

HighMediumLowNonexistent
Have you worked with a Personal Trainer or Life Coach before?

YesNo
If Yes, was it a positive overall experience?

YesNoMixed
At what times during the day would you prefer to train and/or coach?

MorningMid-DayAfternoonEvening
Which days of the week work best for you?

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
When would you like to have your first session?

MonthDayYear
Date
1.) CANCELLATIONS

Please try to cancel or reschedule your sessions at least a day or two in advance in order to give me a chance to rebook the session. Same-day cancellations and "no shows" will be charged for a full session.

2.) LATE ARRIVALS

Each session shall be 1 hour in length. With some exceptions, sessions typically cannot be extended due to the lateness of the client or due to interruptions caused by the client.

3.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential.
I AGREE TO THE ABOVE TERMS & CONDITIONS!

YesNo
Questions/Comments:
Thank you so much for taking the time to complete this form. I should be able to get back to you within 24-48 hours. If you would like a quicker response please shoot me a text at (323) 573-3511.
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