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PERSONAL TRAINING INTEREST FORM

Please note that this is just a request/interest form and does not guarantee a spot in my program. I’m looking for motivated and dedicated individuals who are truly ready to make a change. If you're serious about reaching your goals, I’m here to help, but this will require commitment, consistency, and effort on your part.

My program includes a personalized training, meal, and cardio plan tailored to help you achieve your specific goals. Depending on your goal, you’ll be required to weigh your meals, hit a daily step count, and stay consistent with your training. I can’t make the necessary strategic adjustments to support your progress if we don’t have a clear understanding of your daily macronutrient and caloric intake, as well as your energy expenditure. I’m here to guide you, but I need you to be ready to put in the work and leave the excuses behind. If you're willing to take this seriously and challenge yourself, I look forward to hearing from you.

Please fill out this questionnaire to the best of your ability. The more detailed and specific your responses, the better!

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Email *
Full name: *
Cell Phone Number *
What is your current height, weight, and age? *
What is your occupation? *
Which service are you interested in? *
If you selected In-Home Personal Training above, what is your address? 
If you selected In-Home Personal Training or Online Coaching above, what gym equipment do you have access to? 
(Ex. Gym membership at Planet Fitness, Adjustable Bench and Dumbbells up to 50 lbs, resistance bands and a 25 lb kettlebell, no equipment, etc.)

We are able to provide equipment for In-Home sessions! 
What is your desired outcome of working with me? What are you hoping to achieve? 
(Be specific) 
 *
What is the biggest thing holding you back from achieving your desired outcome?  *
What is the most important thing I can do for you to help you achieve your goal that was previously mentioned? 
 *
How would you describe your habits and routines? (Select one) *
What do you struggle most with fitness and nutrition wise?  *
On a scale of 1-10, how important is achieving your goals to you?
1 meaning not important at all
10 meaning extremely important and I'm willing to do whatever it takes 
 *
Are you willing to make changes to become the best version of yourself? *
Tell me something unique about yourself: *
What is your exercise history? 
(Previous lifting, sports in High/School or College, etc.) 
 *
Do you have any past or current injuries?  *
Are you currently willing to make a financial investment in yourself? *
When is the best time to schedule your consultation? *
How did you find out about Breze Coaching?  *
Please list any questions for me below (if any)
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