Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Which of the following are priorities to you? *

Reduce Body Fat

Tone Muscles

Improve Cardiovascular Fitness

Increase Flexibility

Build Muscle Mass

Increase Motivation

Improve Nutrition/Eating Habits

Reduce Stress

Pre/Post Natal Care

Improve Strength

Improve Functional Movement

Create Healthy, Sustainable Habits

What obstacles and challenges have you faced in the past that kept you from achieving your goals? Check all that apply. *

Lack of Motivation

Lack of Time

Boredom

Health Issues/Injury

Money