LifeReboot Fitness Application Form

1

Are you willing to get uncomfortable to reach your goals?* This field is required.

YESNO

2

Are you willing to change the mindset that got you to where you are right now?* This field is required.

YESNO

3

Are you willing to follow a plan for 12 weeks (90 days)?* This field is required.

YESNO

4

What are you here for?* This field is required.

Lose weight and get leaner

Build muscle and strength

Improve athletic performance

Tone up and look more defined

Boost energy and confidence

Get back on track with healthy habits

Learn proper nutrition and training

Transform my body and mindset for good

5

What's your current fitness situation?* This field is required.Example: I'm a mess. I'm 40 pounds overweight, and my body hurts all the time.

6

What's your dream goal?* This field is required.Example: I'd like to lose 40 pounds and fit into my old clothes again.

7

How long would it take to accomplish this on your own?* This field is required.Example: Forever

8

Do you want to sustain your goal after you achieve it?* This field is required.Example: Of course

9

How long have you wanted to achieve this goal?* This field is required.Example: Since I had my last child, it's been ten years, and I just can't get rid of the weight.

10

Why do you want this so badly?* This field is required.Example: I have a 10-year reunion coming up, and I want to look good.

11

You already know that it's not easy to gain or drop weight. Will you take our recommendations and do what we ask in order to help you reach your goal?* This field is required.

YESNO

12

Why are you applying now?* This field is required.Example: I want to lose weight, and I'm tired of struggling!

13

Why do you think you'll succeed this time?* This field is required.Example: Because I'm committed, and my friend lost weight after joining your gym.

14

Our average client loses or gains 10 or more pounds with us in the first 3 months. Are you okay with this?* This field is required.

YESNO

15

What's your current state? What is your desired state?* This field is required.Example: I'm currently 40 pounds overweight. I want to be down to my college weight.

16

Have you struggled to lose or gain weight in the past?* This field is required.

YESNO

17

Have you struggled with maintaining a self-directed fitness program in the past?* This field is required.

YESNO

18

Do you think you'd lose or gain the weight faster with an expert helping you along the way?* This field is required.

YESNO

19

Do you think you'd lose the weight faster with daily accountability?* This field is required.

YESNO

20

Is it more important that you lose or gain the weight quickly, or that it's permanent?* This field is required.

Lose weight quickly

Gain weight quickly

Make it permanent

21

Name* This field is required.

First Name

Last Name

22

Email* This field is required.

example@example.com

23

Phone Number* This field is required.

Please enter a valid phone number.