Name: *

Surname: *

Phone: *

Email: *

Age: *

Height: *

Weight: *

Do you have any health and medical conditions that may impact your training? How ever insignificant you think it may be, please make a note. : *

Number of years training: *

What is your current training like?:

What are you fitness goals? (Select 4): *

Lose weightGain lean muscle massIncrease overall strengthGet toned and definedImprove cardiovascular fitnessIncrease flexibilityPrepare for a life or athletic eventRecover from an injuryLearn a new movement or toolImprove overall health

Of those you that you mentioned, which is your primary goal?:: *

Please expand on your goals? :

Why is this important to you now?:

I want to maximize my health and wellnessI have an upcoming eventI recently set a goalI am displeased with my current fitness/results

Current Diet:

Realistically, how soon would you like to achieve this goal?: Please selectLess than 1 months2-3 months4-6 months7-12 months

How many days a week are you committed to working out, to achieve this goal?:

What obstacles do you see that might get in the way of achieving this goal?:

WorkFamilyMoneyTimeschoolDiet/NutritionKnowledgeInjuryPrevious failuresNo obstacles

How do you think you will feel once you achieve your goal?:

ConfidentProudEnergizedSense of accomplishmentMotivated

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