Fit-N-Fine intake form

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Welcome to Fine-N-Fine Online
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Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
Area Code
Phone Number
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Email* This field is required.
example@example.com
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What is your current Age?* This field is required.
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What is your current Height?* This field is required.(ex: 5'10")
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What is your current weight?* This field is required.
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What are you trying to accomplish?* This field is required.(Choose ALL that apply)
Rekindle Spouse Attraction
Lose 10-50lbs
Lose 50+lbs
Gain Weight
Lean and Tone / Get Stronger
Decrease Body Fat Percentage
Be Healthy For My Kids
Overcome Anxiety / Depression
Feel Better, Increase Energy, Sleep better, Be More Productive
Gain Confidence and Self-Esteem
Look Better Naked
Improve Lifestyle, Health, and Establish better habits
Become My Best Self
Improve Performance, Strength and Conditioning
Other
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What have you tried in the past in attempt to reach these goals?* This field is required.(Choose as many as necessary)
Gym on my own with no guidance
Personal Trainer
Generic Nutrition Guidance (read from internet, magazine, book, family / friends)
Weight Loss Groups (Jenny Craig, Weight Watchers, etc)
Shake Programs / Juicing
Diet Pills, HCG, KETO
Weight Loss Surgery
Other
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Why haven't you been able to solve your problem on your own?* This field is required.(Be HONEST. Why are you struggling? What is missing?)
Sustainability of the Plan
Need Accountability
Don't Know What To Do
Hit Plateau Then Gave Up
I Am Lazy
Other
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What are your biggest challenges / struggles?* This field is required.(We all have our vices, be transparent so I can help. Choose ALL that apply)
Sweet Tooth
Snacking throughout the day
Stress / Emotional Eating
Late night cravings
Binge Eating
Not eating all day
Eating out
Going to bed late because of electronic devices
Depression
No motivation
Hate working out
No self discipline
Can't stay consistent
Other
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On a scale of 1-10, how serious are you about making this change and solving the problem for good?* This field is required.(If you aren't a 10, that tells us that you aren't all in. If you have been suffering, STOP, and commit to you.)
1-5 - I am not really that serious. (stop filling out form)
6-9 - I am serious but not willing to commit to changing.
10 - I am fully ready for a change NOW and I can't do it alone.
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Are you willing to invest in yourself not just financially, but mentally and physically to make this change?* This field is required.(This isn't a free or easy program. But it is the last one you'll ever need. We solve your problem for good.)
Yes, I am willing to invest in myself to make this change.
No, I am not willing to invest into making a change.
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How soon are you looking to get started?* This field is required.(Are you ready for the best program ever that actually works?)
Immediately! PLEASE PUT ME AT THE TOP OF THE LIST!
I am ready!
Later, I am not ready to change!
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Are you interested in using our Financial Aid Program?
YESNO
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If you answered yes, whats your credit score range?
below 550
550-620
620-700
700+
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Anything else you'd like to share with Fit-N-Fine?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: