Form
Name
First Name
Last Name
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
What is your height?
What is your approximate weight and the goal weight you want to achieve?
Think of a few things you want to accomplish over the next 3 months. Then tell me the #1 goal you have for joining this program.*
Describe your past experiences with exercise, nutrition, & what you've done in the past to reach your fitness goals. What did you struggle with?: (there is no wrong answer here; I want to see you crush your goals!)*
Do you have any movement limitations, chronic health conditions, surgeries, really anything that I should know about to create a program just for you?
*
Please tell me what a typical daily diet looks like for you? Do you need help with nutrition goals?
Do you have a special diet like plant based, carnivore, keto, etc. that you'd like to discuss and possibly change? What has and hasn't worked for you?
Do you prioritize sleep for recovery? How many hrs do you sleep a night?
Tell me how your digestion is. Don't be shy here; I know gut issues all too well
What are you favorite snacks you can't live without? What do you crave but you know it's not the best for you?
I know this is personal but I treat you like family once you're in with me. Please list any and all medications/supplements you take daily. This should include hormone treatments, injections, inhalers ,and so forth
Do you have any of the following?
Asthma; specifically exercise induced asthma
High blood pressure
Diabetes
Dizziness, chest pain, shortness of breath
Family history of heart disease
Connective Tissue Disease
Sleep Apnea
Arthritis
Chronic Pain
Seizures
Neuromuscular Disease
Hormone treatment
Please describe below if you checked any of the above
Are you pregnant or trying to get pregnant?
How did you hear about Still Strong
All of the information I’ve provided above is true to the best of my knowledge and I will let my trainer know as soon as anything changes . Please sign below
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