Results Strategy Consult Intake Form

The Basics
Full name

First NameLast Name
Phone Number
Email
example@example.com
What is your commute time to the studio?
Have you ever been to REV36O?
If you are new, where did you hear about us? If you are a current member where did you hear about the results strategy consultation?
If recommended by a friend, family member or other healthcare provider, please tell us their name so we can thank them.
Let's Get Going

1 star is as poor/little as it can get, 5 stars is as great/high as it can get.
How satisfied are you with your nutrition?
How would you rate your rest/sleep?
How stressful is your job/lifestyle?
Keep Moving

Let's dive into the real support structures..
Out of 5, how satisfied with your fitness are you now?
Out of 5, how satisfied with your strength are you now?
Out of 5, how satisfied with your stress level are you now?
Out of 5, How important is it for you to create change at this time?
If you are currently a member paying a subscription at another fitnesss studio/gym, please tell us the name of that establishment so we can help tailor your options.
If you are a member elsewhere, how long of a contract do you have left in your obligation?
What experience do you have in health & fitness?
Please list everything you do currently for fitness and wellness.
How long have you been thinking about checking out health & fitness options (or changing what you currently do for health & fitness)?
What has stopped you from taking action?
What of the below would you like to achieve in the next 3 months?

Other
Outline your main goal, your main reason for scheduling a results strategy consultation?
What does that goal mean to you?
How will your life change when this goal is achieved?
How important is your goal?
Do you have a timeline to achieve your goal?
What are you most excited about exploring in the consultation today? (choose all that apply)

Other
Of the Below, what two are most important for you when exploring new fitness & wellness options?

Other
Of the below, what would be your preference?
The Future You
If you knew your goal was possible and only dependent on you showing up, how many hours a week can you commit to reaching your goal?
If you knew your goal was possible, how much are you willing to spend per week to reach your goal?

Other
If you could pay with a payment plan or use your HSA/FSA, would this make a difference?
In households, there is often more than one person making finaincial decisions. Will you commit to discussing your budget prior to our consultation so that is not a barrier to your reaching your goals?
What else do your want the consultant to know before your appointment?
Important Notice & DisclaimerThe information provided in this intake form and during your consultation is for educational and informational purposes only and is not intended to diagnose, treat, cure, or prevent any medical condition. Your consultation does not replace medical advice from a licensed healthcare professional.Before beginning any new exercise, nutrition, or wellness program, you are encouraged to consult with your physician or qualified healthcare provider, especially if you have any pre-existing conditions, injuries, or health concerns.While we will use our expertise to guide and support you based on the information you provide, your results depend on many factors, including consistency, effort, lifestyle choices, and individual circumstances. Because of this, we cannot guarantee specific outcomes or results.By proceeding, you acknowledge that you are voluntarily participating and accept full responsibility for your health and well-being.
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The Basics

Let's Get Going

Keep Moving

The Future You