Welcome to URBS GYM
Name
*
First Name
Last Name
Email
example@example.com
What’s the best thing that happened to you in the past 2 weeks due to being on this journey to improved health and wellness? What non scale victories did you notice in the past 2 weeks?
*
Rate your accuracy in measuring how much you were eating and sticking to the Program the past 2 weeks
*
Please Select
Less than 5 (Poor) - did not measure most of my food at all
5-6 (Needs work) - eyeball estimated most of my food
7-8 (Good) - Measured ALMOST every single piece of food I put in my mouth using a scale and wrote it down
9-10 (Excellent) - Measured every single piece of food I put in my mouth using a scale to the last 0.1 gram and wrote it down
What would you like to focus on improving in the upcoming 4 weeks? Would you be interested in nutrition coaching?
*
How can I be a better coach for you? What can I do to help you be more successful with your journey? If you were me helping you, what’s one thing you would do differently?
*
Are you taking supplements?
*
No
Yes
Type any other response (if needed)
Which program your interested?
*
Please Select
3 days a week/4 weeks
2 days a week/ 4 weeks
1 on 1 Personal training
First free class
Nutrition coaching/online
Any Injuries or type of exercises or restrictions you have? comments, questions or concerns? Do you take medication? Please advise.
Are you 18 year old? If not, please have parent sign the waiver below.
Yes
No
Signature
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