TRIMPOSSIBLE Application Form 1-2

Program Application Form

Great, congrats on making it this far! Now, let's get some information from you to figure out where you are, where you can be, and where you want to be! It'll also help us decide together what the best program / package combo is for you, your needs and lifestyle.
Basic Information
Full name*
Date of Birth*

YearMonthDay
Phone Number*
123-456-7890
E-mail*
myname@example.com
Residence Location / Timezone*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Health History
Do you have any health issues and/or pains that you believe might hinder or limit the kind of training and exercises you can do? (There is no right or wrong answer here. You need to be very candid for your own health and wellbeing)
What is your current height?*
in centimeters (cm) or inches (in)*

Centimeters (cm)Inches (in)
What is your current weight?*
in kilograms (kg) or pounds (lbs)*

Kilograms (kg)Pounds (Lbs)
Do you have any dietary restrictions?

VegetarianVeganKosherLactose IntolerantGluten IntolerantNONEOther
Health & Fitness Goals
What are your health and/or fitness goals (choose all that apply)*

Gain StrengthGet TonedLose Body FatGain WeightFix My PostureGet PregnantLose the Pregnancy WeightHave a Healthy Active PregnancyI just need something to help me let-off some steam! GIVE ME A PUNCHING BAG!I JUST WANT TO FIT INTO THIS DANG WEDDING DRESS!Other
How did you hear about TRIMPOSSIBLE FITNESS and/or Coach Mona?*

Friend ReferralSocial Media - InstagramSocial Media - FacebookOther
Which TRIMPOSSIBLE FITNESS program do YOU think is best for you? (This is not final, we will still be discussing what program is best for you together later on)*

TRIMPOSSIBLE for ChicasTRIMPOSSIBLE for Preggo ChicasTRIMPOSSIBLE for MommasNot sure
How do you think a Trimpossible Fitness program can help you?*
Are you willing to invest USD200 - USD600 per month in your health and fitness?

Yes, I am!No, I'm not..
Fitness History
How would you describe your previous training/personal-training experience*

I'm a pro athlete. Arnold Schwarzennegger aint got nothin' on me!I've been training regularly for years. I am one with the gym!I've been training on & off for years, fitness and I have a complicated relationshipI've trained a bit here & there and tried different things, but nothing ever stuckI have no idea what I'm doing and weights scare me!... HELP!
If you have worked with a personal trainer and/or nutrition coach before, what was your experience?
Have you ever tried any of the following programs/routines? (select all that apply)*

CrossfitInsanityP90XBeach BodyDDP YogaPIIT28BBGP.VolveNONEOther
Please list the ones that HAVE worked for you, if any (feel free to explain why)
More About YOU
If you never had to worry about calories, health, weight, nutrition...etc., what food/drink would you eat/drink every day?*
What is your favorite movie/show?*
Which one are you?*

Extrovert (I love being around people!)Extreme Extrovert (If I'm not around people for more than a day I'd go crazy!)Introvert (I would rather spend time with myself and/or alone with someone I like)Extreme Introvert (I hate being around people!)Neither or somewhere in between
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Program Application Form

Basic Information

Health History

Health & Fitness Goals

Fitness History

More About YOU