Initial Consultation form

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Welcome! Thank you for reaching out! Please fill out this form to the best of your ability, the more details the better we can get to know you! See you soon!

Email *

How did you hear about us?

Instagram

Referral

Business card, Ad

Dr. Referral

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If Referral, who referred you?

Full Name (First and Last)

Preferred Email

Phone Number

Age/ Birthday

What Services are you interested in?

1:1 Personal Training

Semi-Private Personal Training (4 People)

Recovery Membership (Infrared Sauna, Normatec Systems, Cold Plunge, Massage Therapy)

Gym Membership

Corrective Exercise Assessment, programming, and Training

Prenatal/Postpartum Specific Training/Corrective Exercise

Trainer Preference

Ryan Declouette (Sports Performance, Strength and Conditioning, Olympic Weightlifting, Corrective Exercise)

Ady Willett (Strength and Conditioning Specialist, Mind-body connection specialist, Sports Performance))

Jonathan Schmidt (Functional Strength and Stability coach, Corrective Exercise, Athletic Training)

Jade Wilson (Corrective Exercise Specialist, Prenatal/Postpartum Corrective Exercise Specialist, Functional Strength Trainer, Longevity Training)

Aly Davis (Functional Strength Trainer, Athletic trainer, Corrective Exercise, Runner specific Training)

Matheus Alonso (Sports Performance, Functional Strength Training, Conditioning)

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If Prenatal/Postpartum, how many weeks are you? (If not Skip or write in N/A)

Workout/Training Experience:

Current activity level/exericse routine:

Have you had a personal trainer in the past?

Yes

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Do you currently see any of the following regularly?

Chiropractor

Physical Therapist

Physiotherapist

Professional Athletic Trainer

Fascial Stretch Therapist

If you checked any of the above boxes, please provide your practitioners name and phone number/email.

Injury history and any current injuries or discomforts?

What are your primary goals, check all that apply.

Corrective Exercise

Functional Strength Training

Accountability

Overall health and wellness

Prenatal/Postpartum Corrective Exercise; pelvic floor rehab

Describe your priorities in a few words (Go crazy here! Anything and everything matters! For Example: My Dog, My partner, My work and social life, Having a balanced lifestyle, Spending time at the beach, etc.)

Preferred Days and times for Training / coming to the gym:

Anything else you'd like me to know!

Thank you so much for reaching out! I will go over your application and get back to you within 24 hours! I will reach out to schedule your complementary assessment soon!

I prefer an email

I prefer a call

I prefer a text

Any of the above I'm just excited!

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Submit

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