Fitness Program Form
Please fill out this form
How did you hear about LTL Fitness?
Your answer
Which program are you interested in? *
There are many programs that are offered by LTL Fitness, please check all that apply.
Name *
Your answer
Age *
Your answer
Current Weight *
Your answer
Height *
Your answer
Sex *
Best phone number/time/day to reach you *
Your answer
Skype/Google Duo/WhatsApp Handle
For online or hybrid personal training only. Please specify which app your handle applies to.
Your answer
Email (If you're interested in occasional newsletters and program promotions)
Your email, as well as any information you provide, is safe here.
Your answer
Where do you live?
Your answer
What is your goal weight?
Whether you want to lose weight or gain muscle.
Your answer
Do you have either of the following (check all that apply)?
Do you have one or more injuries? *
If so, what type of injury?
Your answer
Do you have any limitations as far as body movements that can aggravate or re-injure yourself? *
Your answer
Do you have any other medical conditions that may affect your exercise program (heart disease, high blood pressure, diabetes, etc.)? *
If so, please describe below.
Your answer
Are you on any medications that might interfere with your workouts? *
This includes any medications that may cause irregular heart rate.
Do you have a family history of any medical conditions?
If so, please describe below. *
Your answer
Do you smoke any tobacco products? *
How often do you drink alcohol? *
Have you exercised in the past? *
If so, what type of physical activity?
Your answer
On a scale of 1 to 5, how would you rate your own self discipline? *
Not very discipline
Very discipline
I'm ok with being contacted at the information I provided above to further discuss the personal training program I'm interested in. *
You're done!
Thank you for taking the time to fill this out!
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