You’ve taken the first step toward achieving all of your health & fitness goals!


So that I have a better understanding of your potential program and starting point, please complete the following

Health Questionnaire. After submission, you can expect a followup phone call or email within 24 hours.


Name *
Email *
Sex Male
Date of Birth
Best time of day to workout
How did you hear about us
Please check the box to the left of the condition if you have any of the following:

Heart Disease
Pulmonary Disease
Metabolic Disease
Family History of Heart Disease
High Blood Pressure
High Cholesterol
Sedentary Lifestyle
Chest Pain
Shortness of Breath
Irregular/Accelerated Heart Rate
Arthritis/Joint Pain
Back Pain/Spine Disorder
Musculoskeletal Pain/Injury
G.I. Disorder
High Triglycerides
Food Allergies
Over 69 years of age and not used to being active
Is your physician prescribing medication for a blood pressure or heart condition?
Has a physician ever told you that you have a bone or joint problem that will worsen with exercise?

Others, Please specify

Do you know of any reason why you should not participate in physical activity? If yes Please elaborate.
How many days a week are you currently working out? (0-7x)
How long are your typical workouts? (ie. 30 minutes weights/ 30 minutes cardio, etc)
How many days a week would you realistically like to see yourself working out?
What Are Your Fitness Goals? (weight loss, definition, energy gain, etc.)
What are your interests? (running, biking, swimming, etc)
Congratulations! If you’ve made it this far you are well on your way to achieving any goals that you have set for yourself. Your determination and the correct exercise program will keep you motivated and attaining your goals!




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