Last Name
Date of birth
First Name
Gender
*
Select an option
Phone
*
Privacy Policy
Email
*
What is your Height (Ft. & In.)
What is your Weight? (lbs)*
What is your current address?
*
Please include your full address - street name and number, apt number, city, state and zip code! Please make sure this is your correct and current address!
What primary fitness goals do you have!
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Lose a few lbs? Gain muscle mass? Maintain?
How active is your lifestyle?
Include work environment, the gym, daily steps, sports, activities, etc
How does your Nutrition look? (weekdays and weekends)
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Please provide a food log of what you would eat in a day!
Biggest struggle when it comes to your Nutrition?
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Do you track macros? If so, what are they?
*
How experienced are you with tracking macros?* scale 0 to 10 (0 = NOT experienced, 10 = Pretty Experienced)
1
10
Do you have access to a full gym?
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If not, what equipment do you have available?
If you're currently training, what are you doing?
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Lifting weights? Cardio Only? Class based training? Cross Fit? Etc.
How many days per week are you wanting to train?
*
How stressed do you feel on daily basis?
*
No Stress
Stressed Jess
Do you have any health conditions or injury history we should be aware of?
*
Please Explain!
You're almost done! Just a few more questions :)
Mindset is EVERYTHING >>>>>>
Please explain how you feel ~mentally~ going into the program?
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What PRIMARY mentality-based goals do you have?
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Build confidence? Prioritize YOU more? Self Acceptance?
What do you feel will be your biggest struggle mentally during our time together? Why?
*
Let's think about some potential road blocks to ensure we work through them!
Is there anything else you would like to share?
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How ready are you to prioritize YOU and become your best self yet!*