GEX Intake Questionnaire
Please submit your information and answer a few questions so that we can make sure you have a high likelihood of success!
Email *
What is your First Name? *
What is your Last Name? *
What are your GENERAL goals with respect to your health?
(ex. I want to lose weight/get fit/ be more athletic)
 *
How motivated are you to achieve your fitness goals? *
I plan on being on the couch
If I don't change, I'm going to combust
What is your current fitness situation?  How do you feel? 
(ex.  I'm a mess.  I'm 30 pounds overweight and my body hurts all the time)
 *
What's your dream fitness goal?
(ex. lose 40 pounds and fit into my old clothes)
 *
Have you struggled to lose weight/gain muscle in the past? *
Have you had a fitness coach in the past? *
How do you currently track your fitness progress?   (You may select multiple) *
Required
Anything else we could help you with? *
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