New Client Form

To better serve our clients, we need to know a little more information. Please fill out the form below.

Personal Information
Contact Information
Address
Questionare

How did you hear about us?



What is your goal?

What would you like to specifically change or improve with your physique or figure?

Why is this important?

Why now?

Do you have a time frame in mind for achieving these goals?
YesNo



Number of years at present weight?

Have you ever participated in a weight loss or weight gain program?
YesNo

Have you ever worked with a fitness professional or personal trainer?
YesNo

Have you ever participated in a structured resistance training program?
YesNo

Are you currently working out?
YesNo



Are you currently, or have you ever taken a multi-vitamin or any other supplements?
YesNo



How many times per day do you usually eat, including snacks?

Do you feel drops of energy levels throughout your day?
YesNo



What has stopped you in the past from committing to losing weight/getting into better shape?

If you were to start an exercise/diet program, would there be anyone else who needs to be involved in making this decision?
YesNo



Which nutritionist are you working with?