Contact Name * First Name Last Name Phone * (###) ### #### Email * How can I support you? Weight Loss Build Muscle Improve Lifestyle What's your gender? Female Male Height , Weight , & Age * On a Scale of 1-10 how would you rate your overall current mood & confidence & energy levels? What are your Goals? What specific changes are you truly wanting to experience in your body & health? What's been holding you back from reaching your goals? What is your past & current fitness/physical activity experience? * What is your current relationship like with food? Is nutrition something you'd like advisement on? Do you have any current or past health conditions / injuries? Are you taking any medications? * Describe your current lifestyle * Ex: Busy, Joyful, Sluggish, Not well, Very active, Non active etc. Days & Times you’re available to train Anything else you'd like to share :) Emergency Contact information Budget per month In person solo training, Buddy training, or Online? * In Person Training is Held in a Private Gym in OC Awesome, thank you!Congratulations on taking that first step to a healthier you! I will connect with you soon. If you need to reach me sooner, feel free to contact me by phone.(949) 591-2891
