Join Cuong Strong
Date
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/
Month
/
Day
Year
Name
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Age
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Email
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Phone Number
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Format: (000) 000-0000.
Address
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Street Address
Street Address Line 2
City
State
Zip Code
What is your goal?
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What is your current weight? What is your goal weight?
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What is holding you back from reaching your goal?
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When do you want to start training for your goal?
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What inspired you to contact Cuong Strong?
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Describe your current workout routine
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Describe your current nutrition
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Do you have any of the following conditions? If so, please explain
heart disease
diabetes
respiratory disease
epilepsy/convulsions
orthopedic conditions
thyroid disorder
gastrointestinal disorder
other
Please explain any conditions related to your health
List all medications and/or supplements
Do you drink alcohol or use tobacco products? If so, how much?
Do you have any exercise limitations or food allergies? If so, please explain
What times are you available for personal training?
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Which plan are you most interested in?
1 on 1 Personal training & nutrition (1 session per week or 5 per month) ($270 for the first month then $235 for the next month)
1 on 1 Personal training & nutrition (2 sessions per week or 10 per month) ($490 for the first month then $440 for the next month)
Exclusive gym membership (Personal training plan purchase required, $70 for the first month then $50/month w/ training plan)
Online training & nutrition ($270 for the first month then $235/month)
Meal coaching ($170 for the first month then $120/month)
Contest prep ($290 for the first month then $255/month)
Red light therapy ($80-120/month)
How did you hear about Cuong Strong?
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By submitting this form I agree, I have read, understand, and answered all the above questions fully and truthfully
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