Fitness Profile for EXtreme Personal Fitness

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EXtreme Personal Fitness!

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New Client Information
Name *
Primary Phone Number *

Area Code Phone Number
What is your primary number? (home, cell, work) *

Home Number Cell Phone Work Number Other
Secondary Phone Number

Area Code Phone Number
What is your secondary number? (home, cell, work)

Home Number Cell Phone Work Number Other
Please tell me any information that I may need to know about either of your phone numbers.
Email Address *
What is the best time for me to reach you? When is it easiest for you to respond back quickly to a text message or speak to me by phone? *

7 am - 9 am (Early Morning) 9 am - 12 pm (Morning) 12 pm - 5 pm (Afternoon) 5 pm - 9 pm (Evening) 9 pm - 12 pm (Late Night) 9 am - 9 pm (Anytime)
Where are you from? *

Street Address

Street Address Line 2

City State

Zip Code Country
Please tell me the reasons why

you have contacted EXtreme Personal Fitness.
Please check all that apply. *

Personal Fitness Training Weight Loss/Fitness Coaching Customized Fitness Plan Nutritional Guidance Diet and Meal/Eating Plans
How did you hear about EXtreme Personal Fitness? *

Facebook Linkedin Friends or Family Church Google Search You met me out somewhere We are old friends :) Other
Achieve Your Goals
How long has it been since you have exercised and done some cardiovascular exercise aka cardio? *

3 months 6 months 1 year 2 years 3 years 5 years or more I have currently been doing cardio I have never done any cardio before
How long have you been waiting for this right moment to get started on your fitness/weight loss goals? *

3 months 6 months 1 year 2 years 3 years 5 years or more
What has inspired you to contact me and start a fitness/weight loss program with me? *

Upcoming event (wedding, vacation, birthday) Desire to look better for dating You are uncomfortable with clothes size/body size You are tired of being/feeling tired (low energy) Doctor prescribed & recommended (health issues) Reduce stress & improve quality of life You have not been seeing results You need more motivation You haven't been consistent with your workouts Not sure what to do to achieve goals
Please explain ALL of your answers in the previous question of what inspired you to start a fitness/weight loss program. *
Please check ALL that apply. *

You need more MOTIVATION. You are not sure what to do by yourself. You need better results than what you have been getting. You have not been achieving your goals. You need more energy. You need to be held ACCOUNTABLE. You need more support and encouragement. You need more self confidence & self esteem. You are not happy with your current body weight and/or body fat percentage and BMI. You DESIRE to look better and feel better.
Please tell me exactly what your weight loss or fitness goals or health goals are. *
Why is it important for you to achieve your goals NOW? *
How soon would you like to achieve your fitness/weight loss goals? *

3 - 6 months 6 - 12 months 12 to 18 months 18 to 24 months 24 months or longer
Take Action Today!!

I'm looking for ACTION takers!!! Please tell me that you feel ready to take action and start this program immediately.
Please tell me "Yes I'm all in!!" This way I know you're really truly feeling ready to take action!! *
What are your GOALS? *

Lose weight and burn fat Firm and tone Gain lean muscle Increase energy Decrease stress levels Improve cardiovascular health Increase endurance Sleep better Feel better about yourself Improve self esteem & self confidence Improve overall health Other
When it comes to losing weight and getting in shape, please tell me what is your #1 goal? *
What are the biggest challenges that have stood in your way from achieving your goals? *

You are unsure about what to do in your exercise program. You need more MOTIVATION. Trying to find ways to fit it into your schedule You need more patience to stick with the program long term. Emotional support (from family and friends) Your Diet & Eating Plan Procrastination Having kids takes up my time Convenience (gym too far away) Discipline and need to be held ACCOUNTABLE Staying CONSISTENT with your workouts Other
Please explain every answer you chose in the last question and "When it comes to losing weight and getting in shape, what do you feel are your biggest problems and challenges?" *
When it comes to losing weight and getting in shape, please tell me what is your #1 and biggest fear?? *
When it comes to losing weight and getting in shape, please tell me what are 3 things that you really want to know?? (Besides everything else that you have told me so far.) *
If you could instantly solve one of these 3 problems, challenges, or anything that you have told me so far, what would it be and why?? *
How do you honestly feel when you start thinking about losing weight and getting in shape? *
How do you honestly feel about your overall appearance?? How do you feel when you think about your overall appearance?? How do you honestly see yourself?? *
What will your life be like 3 to 6 months from now if you don't take advantage of this opportunity to achieve your goals? *
If you have any comments please feel completely free to leave them here.
Thank you for your inquiry to

EXtreme Personal Fitness!

I will connect with you shortly.

#TeamAwesome

EXtremeforLIFE.com

My EXtreme Trainer Coming Soon!

Let's Start Your Program Today!

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