TELL ME ABOUT YOURSELF!
Full Name
*
First Name
Last Name
What are your Pronouns
Please Select
They/Them
He/His
She/Her
Other
Use the comment section below to share your pronouns if not listed
E-mail
*
example@example.com
Phone Number
*
(000)999-9999
Format: (000) 000-0000.
What are your fitness goals (Check All that Apply)
*
Improve Posture/Movement
Pain Relief
Build Muscle
Increase Strength
Improve Body Composition
Improve Cardiovascular Endurance
Improve Flexibility/Mobility
Relieve Muscle Tightness
Other
Which Training Services are you interested in?
In Person 1x1
Virtual Training (weekly via zoom)
Customized Online Program
How many days per week do you plan to workout.
1 days per week
2 days per week (recommended for optimal progress)
3 days per week
Availability (Check All that apply)
*
Early Mornings (6am-8am)
Mid Mornings (8am-11am)
Afternoons (11am-3pm)
Early Evenings (4pm-6pm)
Late Evenings (6pm-8pm)
How were you Referred to us?
Move With Ease Website
Instagram
Facebook
A Flyer
Medical Care Practitioner (Doctor, Physical Therapist, Chiro) Write their name below
Web Search
Referred by a person you know- Write their name below
Other
I was referred by:
Any other questions or comments you have before our initial meeting?
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