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Please fill out this form as best you can so we can provide you with the most relevant service.
First name
Last name
Date of Birth
Email
Phone Number
Occupation
Have you been cleared by your doctor for physical activity and exercise?
Do you have any injuries I should know about?
Have you ever worked out in the past? If yes, please provide info on: What you have tried? What worked? What didn't?
What does your diet/nutrition typically look like?
Do You Smoke?
yes
no
socially
On a typical night how many hours of sleep do you get?
4-5 hours
5-6 hours
6-7 hours
7-8 hours
8+ hours
What is your main goal right now?
When would you like to achieve this goal?
3 months
6 months
12 months
Whats your biggest barrier preventing you from achieving your goals?
Are you willing to invest?
What services are you interested in?
Virtual PT Sessions
Online Coaching (Fitness Plans, Nutrition plans/guidance, Habit coaching)
Virtual Group Classes
Workout Videos OnDemand
How many Virtual PT Sessions would you like per week? (if you are interested in this service)
1 Virtual session weekly
2 Virtual sessions weekly
as many as I can get
What time of day would you like Virtual PT Sessions? (if interested in this service)
7:30 AM
8:30 AM
9:30 AM
10:30 AM
3 PM
4 PM
5 PM
6 PM
Which days of the week would you be available for Virtual PT Sessions (if you are interested in this service)
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
When is a good time for us to chat?
I want to subscribe to the mailing list.
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