First step to your success
How old are you?
What’s your weight? (LBS)
What’s your height?
What is your medical history? If you don’t have a medical history, just write 'No’
How has your weight changed over the last year?
What kind of physical activity do you do? If you don’t exercise, just write 'No’.
Running
Walking
Elliptical
Cycling
Rowing
Swimming
Gym
Other
No
How many times a week do you workout?
I am not working out
1 day a week
2-3 days a week
4-5 days a week
6-7 days a week
What do you do for a living ?
Do you experience stress at work? Indicate your stress level on a scale of 1-10
Are your blood work all normal?
How’s your sleep?
How many hours do you sleep at night?
How many steps do you take per day? If you don’t know, just write 'No’.
Have you tried any of the following to reach your fitness goals in the past?
Used a fitness app
Tried a workout plan I found online
Took a group fitness class
Hired a personal trainer
Used fitness supplements
Followed a special diet
Purchased a home fitness device
None of the above
How long has it been since you were in great shape?
0 - 12 months
1 - 3 years
More than 3 years
I've never been in great shape
What is your primary fitness goal?
Build muscle
Get leaner
Gain strength
Improving health
Why did you reach out now?
Full Name
Email
Phone number
State
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