Section 1 of 1
Personal Training Inquiry
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What's your name?
What's your name?
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What's the best way I can reach you?
What's the best way I can reach you?
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Email or Cell (above contact method)
Email or Cell (above contact method)
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Which form of personal training are you interested in?
Which form of personal training are you interested in?
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In-Person at home
In-Person in-studio (South Bend)
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Tell me about your health journey so far.
Tell me about your health journey so far.
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What struggles are you currently facing that inspired you to reach out to me?
What struggles are you currently facing that inspired you to reach out to me?
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What are some goals that you'd like to accomplish within the next 3-6 months?
What are some goals that you'd like to accomplish within the next 3-6 months?
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What is keeping you from accomplishing these things on your own?
What is keeping you from accomplishing these things on your own?
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Have you ever worked with a coach or trainer before? If so, what was that like?
Have you ever worked with a coach or trainer before? If so, what was that like?
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On a scale of 1-10, how ready are you to invest in to your health and into your future self?
On a scale of 1-10, how ready are you to invest in to your health and into your future self?
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0
1
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10
1
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10
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What made you choose this number?
What made you choose this number?
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If you will be training in your home, please list ALL workout equipment at your disposal including the various weights.
If you will be training in your home, please list ALL workout equipment at your disposal including the various weights.
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How old are you?
How old are you?
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Do you have a family history of heart attack, coronary revascularization, or sudden death of a male 55 years of age or under or of a female 65 years or under?
Do you have a family history of heart attack, coronary revascularization, or sudden death of a male 55 years of age or under or of a female 65 years or under?
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Do you use tobacco products, had exposure to (i.e. secondhand smoke), or quit smoking within the previous six months?
Do you use tobacco products, had exposure to (i.e. secondhand smoke), or quit smoking within the previous six months?
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Have you been participating in moderate-intensity physical activity at least 3 days a week for the past 3 months?
Have you been participating in moderate-intensity physical activity at least 3 days a week for the past 3 months?
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What is your BMI? If you don't know just enter your height and weight. :) I'll do the math!
What is your BMI? If you don't know just enter your height and weight. :) I'll do the math!
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Are you hypertensive or on medication for high blood pressure?
Are you hypertensive or on medication for high blood pressure?
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Are you diabetic or prediabetic?
Are you diabetic or prediabetic?
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Has a doctor ever cautioned you in regards to your cholesterol or are you currently taking lipid lowering medication?
Has a doctor ever cautioned you in regards to your cholesterol or are you currently taking lipid lowering medication?
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Thanks so much for answering those questions!!
Thanks so much for answering those questions!!
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I know. I'm amazing.
My pleasure, my treasure!
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