1.  How many days a week are you willing to
exercise??
7.   Do you have any special events coming up?
Yes
No
8.  What specific part of your body would you like
to see the most change in? Explain
2. Would you prefer to work out at a gym or at home?
3.  Do you have access to weights?
9.  Are there any physical obstacles that
would prohibit your from achieving your
goals? Explain
No
Yes
4.  On a scale of 1 - 10, what is your commitment level?     
5.  What is your short term exercise goal?
10.  Do you have support in a spouse, family
member or friend?
Yes
No
6.  What is your 6 month goal?
11.  Do you have any medical issues?
12.  Please list any medications you are
currently taking, including vitamins and over
the counter medications.
Please consult your
physician before
starting any diet or
exercise program.
If you purchase personal training sessions, you can purchase all the equipment you will need for around
$65.00.  Cardio can be done on an aerobics bench or by walking in your neighborhood or local park.
Please provider your name and email below.
YOU MUST submit payment below before you receive an
email to set up your initial personal training session.  
When returned to this page, press submit to start the
process.  Thank you.
Questionnaire
Your answers are completely confidential.  Please answer the questions as honestly
as possible so that your plan can be accurate and comprehensive.
Just one payment of $65.00 will start
you on your journey to a more fit you.  
You will be contacted within 24 hours
to set up your initial screening.