New Client Application

1
Name* This field is required.(Full Names Only)
First Name
Middle Name
Last Name
2
Contact Number:* This field is required.
Area Code
Phone Number
3
E-mail* This field is required.
4
Date Of Birth* This field is required.
Month
Day
Year
5
Gender* This field is required.
Male
Female
Other
6
Height* This field is required.(Feet & Inches)
7
Weight* This field is required.
8
How Can I Help With Your Weight Loss Journey?* This field is required.
Need To Lose 10-25lbs
Need To Lose 25-50lbs
Need To Lose 50-100lbs
Need To Lose Over 100lbs
Other
9
Please List All Major/Minor Injuries & Health ConditionsNon-Disclosed Information Will Result In Removal From Gym
Huge
Large
Normal
Small
Ok
Ok
10
Are Currently Taking Any Medications? (Including Birth Control)?* This field is required.
Yes
No
11
If Yes, Please List It HerePlease list all medications (DRUG NAME, DOSE, FREQUENCY, ROUTE) that you are currently prescribed, if more than one, separate them with a comma.
12
What Is Your Budget For Your Weight Loss Journey?* This field is required.This Helps Me Find The Best Options For Your Goals
$100-$250
$250-$500
$500-$100
No Budget
13
List Any Question, Concerns, or Comments You Have BelowPlease Ask All Questions You Have Here & Save The Rest For Your Consultation Day.
Huge
Large
Normal
Small
Ok
Ok
14
What Days & Times Are You Available To Train?The More Hours & Days Available The Better Chance You Have To Get Booked. Please Be Exact To The Minute (Example 5am-10am)
15
Which Type Of Consultation Would You Prefer?* This field is required.Each Clients Recieves Only 1 Consultation. You Opt Out Of Receiving A In-Person Consultation if You Choose Any Other Option. Any Cancels Are Not Eligible For A Reschedule.
In-Person Consultation
Over-The-Phone Consultation
Text Consultation
No Consultation Needed
16
What Is Your Exact Availability For A Consultation This Week?* This field is required.Be As Detailed As Possible To Ensure We Have Multiple Options To Schedule You
17
Upload A Front Picture* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
18
How Did You Hear About Me?* This field is required.
Instagram
Facebook
TikTok
One Of My Clients
Other
19
Hey, thanks for your submission!!! I look forward to working with you. I've recently had a surge in applications for 1 on 1 personal weight loss training. Im keeping up with demand as fast as I can, while also providing a quality training experience for all of my clients. So I will reach to you as soon as I have spaces open that match your availabilty. I have recieved your application and will work as fast as I can to get you in to the studio and begin working on your weight loss goals next. Thanks for choosing me to be your Weight Loss Coach.

-Grant
Should be Empty: