Basic Information

Full Name*

Birthday*

Year

Month

Day

Email*

Cell #*

Health & Fitness Goals

What are your current fitness goals? (Check all that apply)*

Reduce Menopausal Symptoms

Weight Loss

Muscular Definition (Tone)

Confidence

Appearance

Cardiovascular Endurance

Health

Flexibility / Mobility

Muscular Size (Building)

Strength / Power

Sports Specific

Speed

Stress Reduction

Improve Posture

Reduce Pain

Other

List your top 2 goals from above*

Do you have a specific timeline for your goals? If so, why?*

Which type of progress is more important to you?*

Immediate progress that’s less sustainable

Maintainable progress that may not be as rapid

758 O'Connor Drive

East York, ON, M4B 1J7

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