Free Assesment

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Preferred means of contact* This field is required.

Calling

Email

Text

5

How many days per week do you currently move your body on purpose?Exercise, walking, training—intentional movement.

0

1-2

2-3

3+

6

Do you experience pain, stiffness, or discomfort during daily activities?Back, knees, shoulders, hips, etc.

YESNO

7

How many hours of sleep do you get on average per night?

less than 6

7-8

6-7

8+

9

What is your current weight?

10

Do you know your body composition?

YESNO

11

Can you comfortably walk up two flights of stairs without stopping?

YESNO

12

What is your primary health or fitness goal right now?* This field is required.Weight loss, strength, energy, confidence, medical reasons, longevity.

Weight loss

Strength

Energy

Confidence

Medical Reasons

Longevity

More

13

On a scale of 1–10, how ready are you to make a real change if given the right plan and support?* This field is required.Where is your mind at.

1
2
3
4
5
6
7
8
9
10