New Client Form

New Client

Fill out the form to the best of your ability
Client Name*

First NameMiddle NameLast Name
Phone Number*
Client Email*
Birth Date*

MonthDayYear
Gender*
If female, are you currently pregnant or trying to get pregnant?

PregnantTryingNot pregnantSomeday
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital status*
why do I ask? I want to get to know you and understand environmental factors that influence your lifestyle.
Do you have children? If yes what are their names and how old are they?*
Kids name and age
Fitness Goals*
Be specific
Height*
Weight*
Goal weight*
Where will you work out?*

GymHomeBoth
How many days a week can you workout?*
Which days of the week can you workout?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What time of day works best for you to workout?*

MorningAfternoonEvening
Who supports your decision to get healthy?*
On a scale of 1-10, how committed are you to reach your fitness goals?*

12345678910
Before pictures

You are going to start seeing results immediately. Submit 4 full body well lit photos of you from all 4 sides. (front, back, and bothsides) ***If you purchased in person sessions please disregard.***
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