Online Training Client Application

1
Age* This field is required.
20-30
30-40
40-45
46-50
50-55
56-60
60+
2
Sex* This field is required.
Male
Female
3
Height* This field is required.
Under 5'0
5'0"
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'0"
6'1"
6'2"
6'3"
6'4"
6'5"
Above 6'5"
4
Weight (Pounds)* This field is required.
Under 100
100-110
111-120
121-130
131-140
141-150
151-160
161-170
171-180
181-190
191-200
201-210
211-220
221-230
231-240
241-250
251-260
261-270
271-280
281-290
291-300
301-325
326-350
350-400
400+
5
Do You Have Any Injuries?* This field is required.
Neck
Low back
Shoulder
Knee
Elbow
Ankle
Hip
Wrist
Mid back
Other
None
6
Any Previous Surgeries?* This field is required.
Neck
Low back
Shoulder
Elbow
Knee
Hip
Ankle
Foot
Adbominal
Heart
Brain
Wrist
Other
None
7
Do You Have Any Medical Conditions* This field is required.
High blood pressure
Type 1 diabetes
Type 2 diabetes
Cancer
Autoimmune disease
Asthma
Other
None
8
Are You On Any Medication That Would Affect Exercise/Weight Loss?* This field is required.
High blood pressure
Diabetes/blood sugar
Cholesterol
Antidepressants
Other
C'mon Blaine I'll Tell You Later
None
9
Do You Have Clearance From Your Doctor To Start An Exercise And Diet Program?* This field is required.
Yes
No
No, but I'll get it asap!
10
Occupation* This field is required.
Professional
Business owner
Retired
Other
None
11
How Much Weight Do You Want To Lose (Pounds)?* This field is required.
10-20
21-50
51-75
76-100
101-150
151+
I'm lucky I don't need to lose any weight
I want to gain weight
12
What Are Your Goals?* This field is required.
Weight loss
Better health markers
Feel better
More energy
Better sleep
Stress management
More confidence
Other
More strength
13
What's Stopping You From Reaching Your Goals On Your Own?* This field is required.
Don't know what to do
No time
No energy
Always hungry/cravings
No motivation
No willpower
Need accountability
Need support
I'm outta control! Help!
Other
14
What Else Have You Tried To Lose Weight?* This field is required.
Personal trainer
Weight Watchers
Zumba
Orange Theory
Spin classes
Yoga
Weight loss supplements
Online trainer
Fit Body
Keto
Fasting
Vegetarian
Cardio
Praying
Group classes
Other
None
15
How Did You Hear About Us?* This field is required.
Facebook
Google
Instagram
Radio
Billboard
Client Referral
Mail
Business/Professional Referral
TV
Youtube
Tradeshow
Wellnessnews
Email
Drive By Signage
Phone
In Person Sales Representative
16
What Would You Say Your Weight Training Experience Is?* This field is required.
Beginner
Intermediate
Advanced
17
What Is Your Current Activity Level?
Low
Moderate
High
18
What Type Of Exercise Equipment Do You Have Access To
Dumbells
Barbell
Flat Bench
Adjustable Incline Bench
Power/Squat Rack
Cable/Adjustable Pulley Station
Step Up Platform With Risers
Exercise Ball
Exercise Mat
Resistance Bands
Cardio Equipment
Everything I'm going to a gym
19
What Would Be The Most Important Criteria For Success If We Work Together?* This field is required.
Weight loss
More energy
Better health markers(blood pressure, blood sugars, etc.)
Better sleep
Improved self confidence
Stress management
Be able to function better for activities for daily living
Other
20
On A Scale Of 1-10. 1 Being I'm Satisfied Where I Am And 10 Being I'll Do Anything To Reach My Goal What Number Are You?* This field is required.
1
2
3
4
5
6
7
8
9
10
21
What Do You Expect From Us As Your Coaches?* This field is required.
Accountability
Support
Proper Guidance
Availability to ask questions
Motivation
Other
22
I Understand That Results Are Not Guaranteed And What I Put In Will Largely Dictate My Results.* This field is required.
Yes, I understand
No, I don't understand
23
I Understand That Any Type Of Exercise Program Does Carry An Element Of Risk However Small It May Be And That I Will Not Hold Anyone Responsible Should Any Instance Occur.* This field is required.
Yes, I understand
No, I don't understand
24
If We Work Together And You Have Not Only Reached Your Goals, But We Have OVERDELIVERED On Everything We Have Promised Are You Able To Refer 2 People Of Equal Stature As Yourself That May Need Our Services?* This field is required.
Yes
No
25
Are You Willing To Put In A Solid Effort, Follow The Program, And Train Together For At Least 12-16 Weeks?(Depending On The Program)* This field is required.
Yes
No
26
If You Are Happy With The Results And Our Services How Long Do You Plan On Staying With Us For?* This field is required.
3 Months
6 Months
1 Year +
Forever
Until I reach my goals
27
Are You Comfortably Able To Afford $5000 To Invest In Yourself, Your Health, And The Way You Feel About Yourself WITHOUT It Negatively Affecting Other Essential Areas Of Your Life?* This field is required.
Yes, I can comfortably afford $5000 without it negatively affecting me, my life, or that of my family.
No, spending $5000 on your service will be difficult for me and may negatively affect that of me or my family.
28
Do You Want To Train On Saturdays 8am-3pm?* This field is required.
Yes
No
29
Why Do You Think You Would Be A Good Addition To Our Program?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
30
Out Of All The Options Out There What Is The Reason You Decided To Contact Us/Possibly Want To Work With Me?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
31
Tell Me In One Word Or One Sentence Your "Reason Why" You Want To Do This.
32
Promo Code (Type N/A If None)* This field is required.
33
Name* This field is required.
First Name
Last Name
34
Email* This field is required.
example@example.com
35
Phone Number. (This is your last question. Once you hit "submit" you will be redirected to a scheduling page to book a day and time for a phone call. PLEASE DO THIS AS WE NEED TO DO A PHONE CALL TO PROCEED.)* This field is required.
Area Code
Phone Number
36
Please verify that you are human* This field is required.
37
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