SERIOUS INQUIRIES ONLY!!

SERIOUS INQUIRIES ONLY!!

Local submissions
Name*

First NameLast Name
Email*
example@example.com
Town*
Phone Number*

Area CodePhone Number
Have you ever worked with a personal trainer?*
What is your gender?

MaleFemale
Age Age* . Height Height* Weight Weight*
Desired Weight Desired Weight* Bodyfat % Bodyfat %*
Which program are you interested in?*

36 sessions: nutrition & workouts ($960) pay options: $320 mo / or $80 weekSessions by session, No benefits $45 eachSession by Session, includes nutrition $55Over 65, (no benefits) $35 each session
Please list any Food Restrictions OR Dislikes?*
How much do you know about nutrition?*

1 None23 Somewhat45 I know a lot
Do you have any medical issues?*

High blood pressureHeart diseaseOsteopenia/OsteoporosisEpilepsyDiabetesAsthmaStomach UlcerThyroidKidney diseaseLung issuesDigestive disorders (including acid reflux)AnemiaChronic fatigueHeadachesNeck painBack painNone
In the last year how many times have you worked out in a gym?*

NoneLess than 10Around 50Almost everyday
What best describes your daily activity level?*

Sedentary (minimal exercise)Moderate (3-4x per week)Very active (5-7x per week)
What best describes your body type?*

Ectomorph (naturally skinny, skinny limbs)Mesomorph (athletic build, naturally muscular)Endomorph (Broad, naturally thick)
Where do you feel stuck in your current fitness/nutrition habits?*
What is your comfort level exercising in a gym setting?*

1 Too uncomfortable, won't do it234 very comfortable, doesn't bother me
What is your ideal workout environment?*

At homeAt the gymBoth home & gym
What are your goals?*

Lose weightTone/musclesLearn proper nutritionNeed MotivationGain strengthGain confidenceHealth/Medical reasonsInjury prevention/recovery
Do you have a gym set up at home?*

YesNo
If you have a home gym, what equipment do you have access too? Otherwise NA*
How do you think your trainer will help you meet your fitness goals?*
Please provide a good day and time to speak with me.*
Which days would be best for you to train?*

MondaysTuesdaysWednesdaysThursdaysFridays
How did you find my website and application?*

GoogleAnother gymReferralSocial Media (Facebook/Instagram)
How committed are you to this lifestyle change?*

Not really23 50%45 100%!!!
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