Dream Body Loading Initial Form

Full Name*

First NameLast Name

MaleFemale

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

IG/Tiktok Handle?*

Age*

years

Height*

Weight*

LB

What do you do for a living?*

Yes - I am here for 1:1 Coaching

What is inspiring you to get started with your fitness journey today? Please be as detailed as possible.*

Body RecompLose stubborn fat/ CutGain more muscle mass/ BulkBuild self confidence + self esteem

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?*

How often are you willing to train a week to reach your goal?*

Creating a meal plan which keeps me full and allows me to eat things I enjoyMaintaining consistency in the gym + accountability to my goalsSticking to a workout routine over time which gets real resultsOvercoming body image and confidence concernsFinding/ managing my time to include a healthier lifestyle

YesNo

1.) ALL THE INFORMATION I HAVE GIVEN IS CORRECT

All the information on this form is correct and to the best of my knowledge. I have sought and followed any necessary medical advice. I understand that all the information given will be kept confidential. After submitting this document, Xena's team will review your application and reach out to you in order to schedule your intake call.

YesNo