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You DESERVE a Personal, Simple & Easy Wellness Plan That Works For YOU!
Hi and welcome! My name is Laura Mutz, founder of Chizel Fitness based in Ship Bottom, NJ. I've been a certified fitness instructor for over 30 years and I'm excited to have the opportunity to expand my reach outside of studio to assist others in meeting their fitness/wellness goals.  In order for me to serve you please fill out and submit the short form below. I'll be in touch with you once I've evaluated the information. Thanks for being here- Be Fit, Be Well!
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What Gender Are You? *
What is your age? *
What is your height? (feet/inches) *
What is your current weight? *
What do you feel is your ideal weight? *
How is your diet? Please tell me a little about it: *
What dietary improvements would you like to make? *
What dietary supplements (vitamins/superfoods) are you currently using? *
If you work, what kind of job do you have? (sit at a desk, laborer or something in between?) *
What about structured exercise? How many times a week and what do you do? *
Regarding physical fitness, what would you like to improve?(strength, endurance, flexibility, etc) *
On a scale of 1-10 (10 highest), how committed are you to making the changes you need to meet the above goals? *
How soon would you like to start? (today, next week, etc)? *
What is your name? (first and last please): *
What is the best email to reach you? *
What is the best phone number? I'd like to call you once I evaluate your questionnaire- it's much easier to talk than type! *
Who is the person who referred you to this program? (first and last name please) *
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