Information Form
Please fill out your information for a Free Consultation
Email address *
Phone number: *
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Name: *
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Age: *
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Which service are you most interested in? *
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DOB
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Weight: *
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Height: *
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On a scale of 1 - 10, how would you rate your overall fitness? *
mashed potato on a couch
Batman idolizes Me
What are your goals? (check all that apply) *
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Is this a new goal? (an active pursuit of 6 months or less) *
How much sleep do you get per night on average? What time do you go to sleep and wake up on an average day?
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What worked well for you in the past that helped you get closer to your goals?
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Have you worked with a Trainer Before? *
Please list any medications you are currently taking:
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Do you have any injuries, diseases or illnesses I should know about? *
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NUTRITION:
Please tell me a bit about what you're currently eating and drinking...
Are you currently doing anything specific with your diet or nutrition? If so what type of diet are you following?
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Typical breakfast
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Typical lunch
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Typical dinner
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Typical snacks
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How much water do you drink in a day?
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How much alcohol do you drink a week, and what types?
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List your favorite indulgent foods?
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Do you have any dietary requirements? i.e. vegetarian, vegan, gluten free etc?
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Are you currently or have you ever tracked your food intake? If so how?
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Are you currently taking any supplements? If so please specify: what the supplement is, when you are taking it, how much you are taking and for what reason?
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MINDSET
How long do you imagine it will take to achieve your fitness goal? *
On a scale from 1 - 10, how committed are you to getting results? *
I'm not
Armageddon wouldn't stop me!
What conflicts are currently preventing you from achieving your goals?
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Which service interests you? *
By undertaking training I understand that inherent injury risks are involved when performing physical activities even when performed under the guidance of a professional instructor. I take full responsibility for my personal safety and any injuries I may incur. *
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