Dream Body Loading Initial Form

Full Name

First NameLast Name

Gender

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?

Do you understand that this is for 1:1 coaching that is personalized to you and your life (nutrition, daily chats with me, weekly calls, specified workouts, mindset and habit transformation)

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

What is your primary fitness goal?

Whats the activity level at your job?

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?

Please rate your readiness for change and commitment to starting your journey NOW.

Which of the following areas do you feel that you struggle with the most?

Are you currently excersising regulary (at least 3x per week)?

Have you trained with a personal trainer before?

Are you willing to invest, financially, in this custom 1:1 coaching experience?

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.

I AGREE TO THE ABOVE TERMS & CONDITIONS!