Name *

First Name

Last Name

Lifestyle

Active

Sedentary

Currently Training

Yes

No

Frequency

1

2

3

Other

Have you ever worked with a trainer before?

Yes

No

How many times per week would you like to exercise?

1

2

3

4

5

Other

How much time can you devote to each exercise session?

30 min

1 hour

Other

Primary areas of interest:

Weight Control

Strength Increase

General Health

Hypertrophy

Pre/Post Natal

Sports Specific

Toning – Flexibility

Other

Where would you like to see the most improvement?

Upper Body

Lower Body

Mid Section

Endurance

Other

Why do you feel you are currently not seeing results?

Lack of Motivation

Lack of Training Knowledge

Lack of Equipment

Scheduling

Other

Do you follow any specific diet?

Paleo

Vegan

Vegetarian

Atkins

Blood Type Diet

Keto

Other

Do you know your blood type?

Type A

Type B

Type AB

Type O