Raytrain Client Inquiry Form

Raytrain Fitness

Client Inquiry Form
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Height
cm
Weight
kg
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any injuries? If yes, please list below.
How does your current diet look like?
Do you smoke?
What is your daily activity level?

1

2

3

4

5

1 is None, 5 is High
What is your daily stress level?

1

2

3

4

5

1 is Low, 5 is High
Which (3) days do you want to do personal training a week?
Which of the following statements fit in with your goals?

Other
Which Raytraining program are you most interested in?
How determined are you to see your desired results?

1

2

3

4

5

1 is Worst, 5 is Best
Describe your ideal body goals. Can you be held accountable to put in the effort required to retain this outcome?
Should be Empty:

Raytrain Fitness