Client Application Form

Client Application Form

I aim to offer you an individualized approach through tailored nutrition, training programming, and on-going support to help you best reach your health and fitness goals.

Whether that be building strength, losing weight, or simply optimizing your health and well-being, I will be there with you every step of the way.
Name (First, Last)*
Age*
Height (Example: 5’10”)*
Weight (lbs)*
Email*
Email*
Phone Number*
City*

Street Address

Street Address Line 2

State / Province

Postal / Zip Code
Occupation (This will provide insight regarding your activity level, schedule, routine, etc.) *

Street Address

Street Address Line 2

State / Province

Postal / Zip Code
What are your current training goals? Please explain in good detail.*
What are your current nutrition goals? Please explain in good detail.*
Do you have any medical conditions I should be made aware of? If yes, please explain to the best of your ability.*
Do you have any dietary restrictions? (Only fill out if interested in nutrition consulting)
Do you have any current or past injuries that limit your current lifestyle and/or training? If yes, please explain to the best of your ability.*
How active are you currently?*
Do you have any experience following a training program? If yes, please explain.*
Do you have any experience following a nutrition program? If yes, please explain.*
Where do you complete your current training?*
When are you looking to start?*

MonthDayYear
When is your nearest availability for your selection above?*
What service are you inquiring about?

8 Week Training Program ($200+GST)8 Week Nutrition Consulting ($300+GST)8 Week Training & Nutrition Consulting ($425+GST)12 Week Training Program ($250+GST)12 Week Nutrition Consulting ($375+GST)12 Week Training & Nutrition Consulting ($525+GST)Other (service interested in isn’t listed)
How did you hear about me?*

Referred by a FriendInstagramMy WebsitePast Client of MineOther
If referred by a friend, who? (If comfortable answering)
Should be Empty: