fitness_form

Purchase Information

* Indicates required field

Order number *

Personal Information

Name *

First

Last

Email *

Phone Number *

AGE *

Height *

Weight *

Gender *

Body Fat Percentage *

Goals

What are your physical goals? *

What are your health goals? *

Why do you have these goals? *

How do the people around you support these goals? *

How motivated are you to reach these goals? *

How willing are you to put in the work to reach these goals? *

Do you see any hurdles that may prevent you from reaching these goals? *

Do you have access to a gym? *

Yes No

How many days per week are you able to make it to the gym? *

Lifestyle

How many hours per week do you spend engaging in some type of exercise? *

If you work outside of the home, how physically demanding is your job? *

Health

How would you rate your current health? *

Do you have any physical limitations? *

Do you have any relevant current or past health issues? *

Do you have any health concerns you would like to address in this program? *

Do you have any allergies or food sensitivities? If so, what? *

What are some of your favorite foods? *

What are your least favorite foods? *

Keeping in touch

I will be communicating with you through text message most commonly.
Another method I like to use to communicate with you is a walkie-talkie app called Marco Polo. It's free and can be found on in the app store on both iOS and Android devices.

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