Your Name *

Cell Phone (###)###-#### *

Work Phone (###)###-####

Email *

Best Time To Reach You?

Age *

Height & Weight *

What days & times do you want to workout? *

Are you currently working out? If so, what are you doing?

What is your life like?

What is your schedule like?

Please tell me about your stress level.

Please tell me about your athletic life. Have you ever been fit?

Injuries, surgeries, aches or pains? Please describe.

Are you on medication? Please list & describe.

Family History: Obesity or Eating Disorders? Please describe.

Why do you need a trainer? *

Have you ever had a trainer before? If so, why did you stop?

Do you have home gym equipment or a gym membership?

What would you like to look like?

What would you like to feel like?

Is there anything you'd like to be able to do, that you can't do now?

Please list what you've eaten for the past 3 days: *

How many times a week will you see a trainer?

How many times a week will you workout by yourself?


 Event Based (wedding, photoshoot, etc) Short Term (3-6 months) Medium Term (6-12 months) Lifestyle (1 yr, ongoing)