Contact form

First name
Last name
	Male Female
Phone number
Email
First three digits of postal code

Have you ever worked with a personal trainer before?	Yes No
How would you rate your overall level of knowledge of personal fitness?	None Some High
How would you rate your current fitness?	Not fit Need work Fit

What are your goals?

Goal	Importance (1=low, 5=high)
Learn proper exercise technique	1 2 3 4 5
Lose body fat	1 2 3 4 5
Build muscle	1 2 3 4 5
Improve posture/balance	1 2 3 4 5
Improve general health	1 2 3 4 5

Do you have any medical or other conditions that might limit your ability to do physical activity?	Yes No
If yes, please explain

What kind of training are you interested in?

1 on 1

2 on 1

Group (up to 8 people; join an existing group or start your own)

Bootcamp

Don't know

Which days and times are best for you to train?

	Mon	Tue	Wed	Thu	Fri	Sat	Sun
From
To

Any questions or comments?