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First Name
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Last Name
Email
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Phone
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City
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State
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Are you focused on quick results or a permanent solution?
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I want to get results and keep them
I want results fast and am not worried about keeping them
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What is your primary fitness goal?
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Lose Weight
Gain Muscle
Total body transformation!
Other
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Why is that important to you?
What do you struggle with the most?
Specific Body Part Pain
Consistency/Accountability
Food/Meal Plan/Diet
Other
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What physical limitations do you have?
How much sleep do you get a night?
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3-4 hours
5-6 hours
7-8 hours
8+ hours
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Do you have a nightsleep routine?
Yes and consistent
Yes and inconsistent
No
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Do you have gym membership?
Yes
No
What workout and exercise equipment do you have at home?
How long do you want to exercise?
Less than 10 minutes
10-30 minutes
30-45 minutes
45+ minutes
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When is the best time for you to workout?
Morning (Before 11am)
Midday (11am-2pm)
Early Afternoon (2pm-5pm)
Evening (5-8pm)
Late Night (8pm-11pm)
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How often do you want to exercise in a week?
1-2 days / week
3 days / week
5 days / week
7 days / week
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How many steps do you get in a day?
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Under 10,000
Over 10,000
Not sure
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Do you have any eating restrictions?
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Yes
No
When is your first meal?
5am-7am
7am-9am
9am-11am
After 11am
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When is your last meal?
5pm-7pm
7pm-9pm
9pm-11pm
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What is your daily water intake?
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A few cups
A gallon
More than a gallon
Not sure
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What have you done in the past to reach your goals?
What are you currently doing to reach your goals?
How long do you think it will take you to reach your goal by yourself?
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1-3 months
3-6 months
6-12 months
12+ months
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WHAT IS THE BEST VERSION OF YOURSELF THAT YOU ASPIRE TO BE?
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