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CONTACT INFO

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Name *

First

Last

Email *

Phone Number *

Why are you considering working with a personal trainer? *

What is your primary fitness goal (try to be as specific as possible)? *

What are your favorite activities/ways to be active? *

On a scale of 1-5 (1 = low, 5 = high), how would you rate your current fitness level? *

(Check many best

How often do you currently exercise (days per week)? *

How many days per week would you realistically be able to see a trainer? *

What are the best weekdays for you to commit to trainer? (Check all that apply) *

What time of day do you prefer to exercise? (Check all that apply) *

On a scale of 1-5 (1 = low, 5 = high) how would you rate your commitment level? *

Please list anything else you feel may be useful for me.