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CLIENT CONSULTATION REQUEST

Please fill out the following information then Request to Book your in-person consultation below.

First Name

Last Name

Phone

Date of Birth * required

Height

Weight

Emergency Contact

Emergency Contact Phone #

CURRENT LIFESTYLE & GOALS

My current activity level is *

Sedentary

Active

Physically Demanding

Tobacco Use: *

Yes

I currently work out ___ times per week

When I workout, I complete the following activities / additional details.

I typically eat ___ meals per day

When I eat/snack, the following are the types of foods/meals I eat on a regular basis.

When it comes to hydration, I typically drink _____water per day

GOALS: (check all that apply)

Improve cardiovascular fitness

Facilitate body-fat weight loss

Improve performace for a specific sport

Improve Flexibility

Reshape/tone body

Increase Strength

Improve mood + ability to cope with stress

Short Term Goals (3months or less)

Long Term Goals

On a scale of 1-10 (with 10 being the most confident), how confident do you feel in your ability to stay consistent with your fitness goals?

Rank the following in order of Importance (1 being most important)

Mobility Improvement

Weight Loss

Strength Gain

Muscle Gain

Postural Improvement

WORKOUT HISTORY

Positive Experiences

Activities/Movements/Exercises Enjoyed

Negative Experiences/ Obstacles to Success

Activities/Movements/Exercises Disliked

Do you prefer *

Working out alone

In a group

With a trainer 1:1

Variety

What type of coaching motivates you most? *

Encouraging & Supportive

Tough Love / Accountability-Driven

Educational (want to understand why)

Just tell me what to do

INJURIES/RESTRICTIONS

Please check any of the following that apply or have applied in the past:

Heart Condition

Diabetes or Blood Sugar Imbalance

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High Blood Pressure

Asthma or Breathing Difficulty

Joint Issues (knee, hip, shoulder, spine)

Surgeries or Hospitalizations

Chronic Pain or Inflammation

Other

Thanks for submitting!

Service Information

Training Consultation & Free Session
Limit 1 Per Customer
1 hr 15 min
Request to Book

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CLIENT CONSULTATION REQUEST

Training Consultation & Free Session