Let’s work together

Name *

First Name

Last Name

Phone *

(###)

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Date of Birth *

MM

DD

YYYY

Emergency Contact *

First Name

Last Name

Phone *

(###)

###

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What Are Your Fitness Goals *

Choose all that apply

Lose Weight

Build Muscle

Improve Endurance

Increase Strength

Improve Mobility/Flexibility

Train for a Specific Sport/Event

General Health & Wellness

Do you have any current injuries, medical conditions, or physical limitations? *

No

Yes (Please Explain)

Have you ever had any surgeries or past injuries that may impact your training? *

No

Yes (Please Explain)

How would you describe your current fitness level? *

Beginner (little to no experience)

Intermediate (some fitness experience)

Advanced (consistent training for years)

How often do you currently exercise? *

Rarely or never

1-2 times per week

3-4 times per week

5+ times per week

Preferred Training Time *

Morning

Afternoon

Evening

Do you have any specific challenges or concerns regarding your fitness journey?

No

Yes (Please Explain)

Are you interested in nutrition coaching? *

No

Yes

Waiver Signed? *

Yes

No