Your fitness journey begins with one decision,
commit to yourself today!

If you're scheduled for Fitness Coaching for the first time please complete the intake form below

If you have questions and/or need additional assistance

please feel free to reach out

Fitness Coaching Intake Form

Full Name

Address

Phone

Birthday

Month

Day

Year

What kind of training sessions are you interested in?

Group Training Sessions

Private 1:1 Sessions

Do you currently have Medicaid health insurance?

Your health matters. How much does it matter to you? 1-5 (1 being the least, 5 being the most)

On a scale of 1-5, with 1 being very poor and 5 being excellent, how would you rate your current mental health?

A year from now, what does your dream body look like?

What are some of the obstacles dropping you from achieving your fitness goals? (lack of motivation, eating habits, no accountability, etc.)

How much progress have you been able to accomplish on your own?

Are you interested in group sessions or personal training sessions?

Are you currently injured or have any old injuries that may require modifications? If so, what are they? (Ex: left knee, lower back, right shoulder, etc.)

LIFESTYLE WELLNESS CENTER

Your fitness journey begins with one decision,
commit to yourself today!

Fitness Coaching Intake Form

Quick Links

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Contact

LIFESTYLE WELLNESS CENTER

Your fitness journey begins with one decision, commit to yourself today!

Fitness Coaching Intake Form

Quick Links

Business & Legal

Social

Contact

Your fitness journey begins with one decision,
commit to yourself today!