Help Me Help You
I can give you the Keys; But it is up to You to Open the Door...
Part 1. Basic information
Full Name
First Name
Last Name
Instagram Username/Phone Number
Email
example@example.com
Gender
Male
Female
Age
Years
Height
Inches (e.g. 5'4 = 64 inches)
Weight
Lbs
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
None (seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
Please list the physical activities that you participate in outside of the gym and outside of work
Do you have an Apple Watch, Fitbit, or something to track Daily Steps?
Yes
No
How many Steps do you get on average Daily?
Under 6k Steps a day
6-10k Steps a day
10-15k steps a day
I'm not sure
How are your Eating Habits? (how many meals a day, small or large, healthy or unhealthy, etc.) Please be as Descriptive as Possible.
Is there any Foods you cannot eat, or don't prefer?
Part 3. Medical and Health Information
If you have any diagnosed health problems list the condition(s).
If you have any injuries, please list them.
Part 4. Goals
Please rate your Readiness for Change.
1
2
3
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5
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8
9
10
Are you looking for In-Person, Online, or Hybrid (both) Training?
In-Person Training
Online Training
Hybrid Training
Nutrition ONLY
What following Goals best fit in with Your Goals?
Increase Muscle
Fat Loss
Increase Strength
Improve Overall Health
What is Your Goal with Your Training? Why?
What Is Holding You Back the Most?
How often are you willing to train a week to reach your goal? (IN-PERSON ONLY)
e.g. 3x a week
Please rate your motivational level to do what it takes for reach your Goal(s).
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10
Are you currently exercising regularly (at least 2x per week)?
Yes
No
Have you trained with a personal trainer before?
Yes
No
What kind of training did you do?
How often do you want to do Personal Training a week? (IN-PERSON ONLY)
Please Select
1 Session
2 Sessions
3 Sessions
4 Sessions
5 Sessions
6 Sessions
7 Sessions
Please Choose
At what times during the day would you prefer to train? (IN-PERSON ONLY)
Morning
Afternoon
Evening
Times Vary
Why is it Important to You to make this Change?
Please Read The Following Terms and Conditions
Submit
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