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Basic Information
Full Name
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Birthday
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Year
Month
Day
Email
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Cell #
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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
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