Mailchimp Survey

Personal Training Application

Tell us a more about your fitness goals and why you contacted us today!
First Name
*
Last Name
*
Email Address
*
Check this box to complete the inquiry process. We will send you an email
Phone Number
*
What inspired you to reach out to us today?
What are you currently doing for exercise?
*
What have you done in the past for diet/exercise? What worked for you and what didn’t?
Weight loss is a current goal of mine.
*
0 is Not at all
10 is Primary Focus
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Not at all
Primary Focus
IF weight loss is your goal, how much would you like to lose?
0-5lbs
6-10lbs
11-20lbs
20lbs +
Strength training and building muscle is a goal of mine.
0 is Not at all
10 is Primary Focus
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Not at all
Primary Focus
How motivated are you to achieve your goals?
*
0 is Not motivated
10 is I will do what it takes
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Not motivated
I will do what it takes
How would you rate your immediate support system? (spouse, friends, close family etc.)
0 is No support
10 is Very supportive
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No support
Very supportive
Are you willing to invest the time, money and energy into your goals?
*
0 is I am ok with failure.
10 is I will do what it takes.
012345678910
I am ok with failure.
I will do what it takes.
What time of the day works best for you to exercise?
*
5am-7am
8am-10am
11am-1pm
2pm-4pm
After 5pm
Realizing it will require meeting with your coach 2+ days a week to achieve meaningful results, do you have this much time to dedicate to your health?
0 is I can't make time
10 is It will be a priority
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I can't make time
It will be a priority
After you submit your application, look for an email to get your free Gym Discovery Session booked.