Consultation Form (Gen)

1

Full Name* This field is required.

First Name

Last Name

2

E-mail

3

Gender* This field is required.

Male

Female

4

If qualified, do you have preferred start date?* This field is required.

5

Age

years

6

Weight* This field is required.

lb

7

Height* This field is required.

Inches

8

Contact

Country Code

Area Code

Phone Number

9

Referred by? If YES please provide the name.

10

What do you do for a living?

11

Describe your familiarity with counting calories and macros. If you don't have any experience, are you willing to learn?

12

Do you smoke? If YES how many per day and if you recently quit how long ago? and are you on nicotine patches?

13

Check any that applies

I am looking to lose body fat and "get ripped"

I am looking to build lean muscle mass

I am overweight or obese, looking to lose weight and fat and overall improve my health status

I am interested in competing in bodybuilding, bikini, figure or lean out for photo shoot

I have weird "work" schedule and want a flexible training and nutrition program .

I am a busy mom and need a short & flexible training and nutrition and still achieve my body goal

I am busy entrepreneur I need a program to fit my busy life so i have more time to build my business while staying in shape.

Hmm? I don't know maybe I just want to look great naked.

14

If known, what is the current amount of daily calories?

15

Within the last 6 months have you lost weight ? 15lbs or more? and regained it all back?

YESNO

16

If yes, Did you gain everything or any weight back?

17

What personal barriers do you feel are keeping you from reaching your nutritional and fitness goals?

Lack of motivation

Time

Self Conscious

Lack of equipment

Lack of Results

Hitting A Plateau

Not knowing where/how to begin

18

Do you currently exercise on a regular basis?

Yes

No

19

If yes, how many days a week?

20

Do you have access to fully equipped gym?

Yes

No

Limited Access or partially equipped

Home Gym or willing to invest (resistance bands, kettle bells or dumbbells)

21

Average Daily Activity For The Day* This field is required.Minimal or no exercise for the day.

Low

Medium-Low

Medium

Medium-High

High

22

What do you think is your biggest challenge in achieving your goals?

23

What have you tried in the past that has not worked for you? And what has worked for you?

24

What energizes you in the present? Think about a recent moment when you were happy. What was it about that moment that made it good for you?

25

What motivates you?

Need a strong motivator to push you to exercise

You like to be informed about your program and how it is going to lead you to your goals

Like to try new things if they are effective

Willing to push past your comfort level to reach your goals

if I feel things are really hard I tend to back off

Need to be held accountable for what I am doing

Being sore the day after a workout tells me my workouts are working

27

Which newsletter you would be interested in receiving in the future?

fat loss tips

Supplements

Different Types of Training & Techniques

Diet & nutrition method

Stubborn Belly Fat

28

What is best way to contact you?

Phone

Facebook or Social Media

Text Message

Email

29

Are you ready to invest accomplishing your goals TODAY?