Interested in Personal Training
Full Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Zip Code
Member Status
*
Member
Non-member
Have you done your Fitness Health Appraisal with us?
*
Yes
No
Trainer Preference
*
Male
Female
No preference
Are you interested in any specialized personal training?
Aquatic Personal Training
Muscle Activation Techniques (MAT)
Running Programs
Sports Performance Training
What days work for you?
*
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
And times?
*
Early mornings (before 8:00 am)
Mornings (8:00 am - 12:00 pm)
Afternoons (12:00 pm - 4:00 pm)
Evenings (4:00 pm - 7:00 pm)
Late evenings (after 7:00 pm)
Please indicate your personal health & fitness goals (check all that apply).
*
Lose weight
Feel better/more energy
Cardiovascular fitness
Improve flexibility
Improve balance/stability
Injury rehab
Lower cholesterol and or blood pressure
Improve muscle tone/strength
Improve athletic performance
Pre/post-natal
Reduce stress
Reduce back pain
Learn how to use specific equipment
Create a program to use at home
General fitness
Do you have any physical or medical concerns that need to be addressed or that your trainer should be aware of?
Yes
No
I'm not sure
Please explain
Additional comments, questions, or goals
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