Weight Management Program Intake Application
Thank you for considering 'DynaMike Fitness' for being a part of your active lifestyle. My team and I am looking forward to working with you in this Weight Management Program 'Boot Camp 2.0'. Please know this program is a holistic approach to your wellness, it is not intended to be used simply as a daily workout. You will be expected to adhere to much more if you are to reach your wellness goals. There is so much more to it and we will guide you through your journey. We will take some time to discuss the information you enter in this Client Information Package . This is an important comprehensive questionnaire. It will help me design an appropriate program for you based on your goals, needs and interests. This is a results oriented program and although we'll have fun, understand that the work isn't just during in-class session. After-all, I assume you are committed to your goals and take them seriously, and therefore so do I. Adherence to your program is of utmost importance.
Please complete all sections on each page as thoroughly as possible. If at anytime you get stuck feel free to contact me for help: either call, text or email. I'll respond as soon as possible.
*For more information about On-line Coaching verses In-Person Training please visit
You will find the following sections in the Client Information Package
Medical History/Emergency Questionnaire
Lifestyle & habits Questionnaire
Exercise History Questionnaire
Nutrition & habits Questionnaire
Goal setting Questionnaire
Client release and knowledge of agreement
Mike Clansey, CPT
"I strive to influence the quality of life for you and your family by providing services, education and resources that empower you to attain/maintain physical fitness, manage nutritional objectives, and prolong your life, health and overall wellness" - Mike
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