Well Beyond Application

Go Well Beyond

make it a lifestyle
Name*

First NameLast Name
Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Occupation*
Sex*
Age*
BIRTH Date *

MonthDayYear
Date
In a few sentences, tell me a bit about you - hobbies, family, fun facts. This helps me get to know you personally!
Health history (check all that apply):*

History of heart problems, chest pain, or strokeCurrent chronic illness or conditionPrevious chronic illness or conditionElevated blood pressure currentlyAdvice from physician to not exercise currentlyRecent surgery (last 12 months)Currently pregnantPregnant within the last 3 monthsCurrently breastfeedingHistory of breathing or lung problemsBreathing or lung problems currentlyPast smokerCurrent smokerMuscle, joint, or back disorder, or any previous injury still affecting youType 1 DiabetesType 2 Diabetes currentlyElevated blood cholesterol currentlyHistory of heart problems in immediate familyHernia, or any condition that my be aggravated by lifting weights or other physical activity.Weight loss surgeryNONEOther
Please provide additional detail for ALL items checked above. or any additional medical conditions/physical limitations:
What are your general health, nutrition & fitness goals? (mark all that apply)*

Fat lossGain weightBe fit/strong/athleticReduce bloatingImprove metabolismCreate strong healthy habits, routines, & ritualsLive my healthiest life (realistically & sustainably)Eat intuitively/stop using MyFitnessPal (food tracking)Fuel for sports/athleticsImprove nutrition choices/quality/habitsImprove nutrition consistencyImprove general healthManage/improve health conditions (diabetes, blood pressure, cholesterol, etc.)None of the aboveOther
Tell me more about your goals. Tell me exactly what you want to accomplish & create. Share all details, get specific.*
If you selected 'manage/improve health conditions', please share details.
Types of exercise you enjoy (mark all that apply)*

WalkingRunningDancingSwimmingCyclingSportsWeight liftingCircuit/interval trainingFunctional fitnessConditioning (higher intensity)Pilates/BarreYogaBoxingMartial ArtsOther
What type of support are you interested in? *Mark all that apply**

Personalized plan/protocol (nutrition and/or exercise)Messenger support, coaching, guidance, accountability, & motivationApp workouts to complete on your ownIn person personal training (for LOCAL residents only)
Anything else you'd like to share/questions you have?*
How did you hear about Well Beyond*
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Go Well Beyond