Have you ever worked with a personal trainer before? *

Yes

No

Are you interested in live training/coaching or virtual? *

Live

Virtual (Zoom/Facetime/etc)

How would you rate your current nutritional habits? *

I'm not sure

Poor (fast food once per week; consistent desserts, etc)

Mostly good, but I cheat once per week

Cheat meals maybe 2x per month

Great, consistent

How many hours of sleep to you average per night? *

1-3

4-6

7-9

10+

Would you consider yourself a disciplined person? *

Yes

No

How many total hours per week do you have to dedicate to your own personal development? *

(This could mean training, reading, etc)

3-4

5-6

7-9

10

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *

Yes

No

Do you have any previous injuries? *

Yes

No

Do you feel pain in your chest when you perform physical activity? *

Yes

No

In the past month, have you had chest pain when you were not performing any physical activity? *

Yes

No

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes

No

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

Yes

No

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *

Yes

No

Do you know of any other reason why you should not engage in physical activity? *

Yes

No

Name *

First Name

Last Name

Ok to text? *

Yes

No