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*
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
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 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.*
What are your current training goals? Please explain in good detail.*
Where do you complete your current training?*
If at home, what do you have for equipment? (Please list everything).
Do you have any experience following a nutrition program?*
IF inquiring about nutrition consulting, what are your current nutrition goals? Please explain in good detail.
IF inquiring about nutrition consulting, do you have any dietary restrictions/preferences?
When are you looking to start?*

MonthDayYear
When is your nearest availability for a phone consultation given your preferred start date selected 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)1on1 In Person Training2on1 In Person TrainingGroup TrainingOther (service interested in isn’t listed)
*Terms and Conditions* (If selecting training and/or nutrition consulting).*
How did you hear about me?*

Referred by a FriendInstagramWebsitePast Client of MineOther
If referred by a friend, who? (If comfortable answering)
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