Let’s Work Together

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Pronouns *

she/her

he/his

they/them

other (please let me know below)

What are your primary goals? *

Check all that apply

build strength

sport specific

rehabilitate injuries

change body composition

improve posture/alignment

muscle gain

increase muscular endurance

increase energy levels

improve cardiovascular endurance

decrease stress

improve flexibility

increase power

Other (please describe below)

On a scale of 1-10 (10 being most) how serious are you about accomplishing these goals now? *

1

2

3

4

5

6

7

8

9

10

What's your timeframe to accomplish your goals *

1-Month

3-Months

6-Months

9-Months

12-Months or more

What times of day are you typically available to train together? (check all that apply) *

Early AM

Mid-AM

Lunchtime

Mid-Afternoon

Late Afternoon

Evening

Weekends

How many days per week do you currently exercise? *

0

1

2

3

4

5 or more

How many days per week do you plan to exercise? *

1-2

2-3

3-4

4-5

5 or more

How long are your current workouts?

under 30 mins

30-60 minutes

over 60 minutes

Have you worked with a coach or trainer before? *

Yes

No

How much support do you need? *

Lot's. I am a total beginner and exercise is not yet a part of my regular routine.

Some. I have been in the gym in the past, but I need help with form and accountability.

A little. I know my way around the gym and proper form, but I'd like to make training more of a priority and have an extra set of eyes.

Not much. I'm looking for an extra mind or some new programming to play with on my own.