first things first...let's get to know you!
first name
last name
email
address
city
state
zip
phone
age
height
weight
what is your current activity level?
low (inactive, sits behind desk all day)
moderate (somewhat active, moves around throughout the day)
high (very active, moves constantly throughout the day)
What is your training goal?
recover from injury
general fitness and weight loss
sports performance
Which area would you like to focus on?
weight loss
muscle tone
general fitness
circuit training
increased strength and performance
stay young (50 years +)
Where do you prefer working out?
fitness center
outside
home
Fitness commitment level in days per week.
1
2
3
4
5
6
7
we encourage submitting a picture and taking measurements to determine the progress made throughout the program
Has you doctor ever said you have a heart condition and recommended only supervised physical activity?
yes
no
Do you have chest pain brought on by physical activity?
yes
no
Do you ever lose consciousness or fall over as a result of dizziness?
yes
no
Has a doctor ever recommended medication for your blood pressure or a heart condition?
yes
no
Do you have a bone or joint problem that could be aggravated by the proposed physical activity?
yes
no
Are you over the age of 65 and not accustomed to vigorous exercise?
yes
no
Do you have any food allergies, intolerances, dietary restrictions or specific doctor recommendations? Please list.
**no worries, your personal information will remain confidential
**please consult with your personal physician prior to beginning an exercise regimen
