New Client Form

/New Client Form
New Client Form2017-03-31T01:51:37+00:00

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
What is the best way to reach you?
Address
Questionnaire
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 your energy drops 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 if applicable?
Skype/Google Hangout Clients
Are you a Skype/Google Hangout client? NoYes
What platform do you wish to be contacted on? SkypeGoogle Hangout
What is your morning weight? Please provide circumference measurements of the following: