Have you worked with a trainer before?

 

Yes No 

 

 

If yes, why did you stop?

 

 

What time of day would you prefer to train?

AM      PM      Flexible

 

 

Please check any previous or current injuries that apply:

 

Knees   Shoulders   Back   Neck     Arms or Legs

Other:

 

How do you rate your current fitness level?

Athletic Fairly Active Injured and inactive Some what overweight Complete couch potato

Please briefly describe your current goals for your physical and mental Health:

Tell us how to get in touch with you:

Name
E-mail
Tel
FAX

Please contact me as soon as possible, I am ready to GET BUSY LIVING!