New Client Questionnaire

About you!

Please answer the questions below to receive your personal fitness plan, nutrition plan, and membership options. There are no obligations. All of your information will be kept confidential.

Full Name*

First NameLast Name

E-mail*

Pronoun

She/HerHe/HimThey/Them

What is your current age?*

Where do you live?*

What are your fitness and health goals? *

What keeps getting in your way? Time? Energy? Food choices? Not knowing what to eat?*

What do you enjoy doing to be active?

What have you tried?

What has worked for you?

Are you currently on any medications or diagnosed with any health issues or disease?*

YesNo

If yes, please provide details below.

Do you have any physical or dietary restrictions?*

YesNo

If yes, please explain below.

Are you currently working with another Beachbody Coach?*

YesNo