IMPACKT Fitness Training Inquiry

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For hybrid or online coaching inquiry

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Full Name* This field is required.

First Name

Last Name

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Gender

Male

Female

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Date of Birth

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Mailing Address

Street, City, State, Zip

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Contact number* This field is required.

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Email Address* This field is required.

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What do you do for a living?

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Whats the activity level at your job?

none(seated only)

Moderate (light activity such as walking)

High (heavy labor, very active)

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What are some of your hobbies? (reading, gardening etc)

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Please list the physical activities that you participate in outside of the gym and outside of work.:

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How many hours of sleep do you get per day?

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Are you experiencing any stresses or motivational problems?

Yes

No

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Are you a current cigarette smoker?

Yes

No

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What is your specific goal with your training?

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What are your top 3 fitness goals?

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

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Are you currently exercising regularly (at least 3x per week)?

Yes

No

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Have you trained with a personal trainer before?

Yes

No

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If yes, what kind of training did you do? Tell me about that experience

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How often do you want to do Personal Training a week?

Please Choose

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What are your expectations of me as your Personal Trainer?

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How did you hear about ImPACKt Finess?* This field is required.

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When is the best time to reach you by phone?

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I have answered all questions honestly and to the best of my knowledge. By submitting, I opt in to also recieve periodic fitness and nutrition tips.

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I AGREE TO THE ABOVE STATEMENT* This field is required.

Yes

No