Choose your pricing plan

PERSONAL QUESTIONNAIRE FORM

Please take a moment to fill out the form.

First Name

Birthday

WHERE DO YOU WORK OUT

Last Name

Phone

HOW OFTEN DO YOU CONSUME ALCOHOL

HOW OFTEN DO YOU EAT OUT

WHAT IS YOUR HEIGHT & WEIGHT

CURRENT NUTRITION REGIME. HOW ARE YOU EATING? INCLUDE WHAT 1 WEEK DAY & 1 WEEKEND LOOKS LIKE FOR YOU

Health History Including Surgeries, Medications, Injuries, & Health Conditions

CURRENT WORKOUT REGIME

WHAT WORKOUT EQUIPMENT DO YOU HAVE AT HOME

I UNDERSTAND TO BE SUCCESSFUL, I WILL NEED TO STICK TO THE EXERCISE/NUTRITION PROGRAM.

I UNDERSTAND I WILL HAVE WEEKLY CHECK INS.

I UNDERSTAND I WILL HAVE TO SEND WEEKLY PROGRESS PICTURES.

I WILL BE HONEST ABOUT MY FAILURES & ACCOMPLISHMENTS EACH WEEK. TRANSPARENCY IS KEY.

I UNDERSTAND THIS IS A NON REFUNDABLE PROGRAM. FAILURE TO COMPLETE PROGRAM WILL NOT RESULT IN A REFUND.

WHAT ARE YOUR FIITNESS/ HEALTH GOALS?

PLEASE SHARE ANY INFO YOU WOULD LIKE TO ADD

Thanks for submitting!