Contact
Information
First
Name
Last
Name
Company
Name
Street
Address
Apartment/Unit
#
City
State Zip Code
Email
Phone
Best Day
& Time To Call
How
Did You
Hear About Us?
Background
& Goal Setting
What sport(s) do you currently
participate in
Position(s)
Number
of Years In Each Sport
If
you could choose 3 goals, what would they be?
Goal #1
Weight Loss
Weight Gain
Eat Better
Gain Strength
Improve Flexibility
Improve Top Speed
Improve Acceleration
Improve Endurance
Improve Form/Technique For Lifting
Decrease Reaction Time
Improve Balance
Improve Agility
Other
Goal #2
Weight Loss
Weight Gain
Eat Better
Gain Strength
Improve Flexibility
Improve Top Speed
Improve Acceleration
Improve Endurance
Improve Form/Technique For Lifting
Decrease Reaction Time
Improve Balance
Improve Agility
Other
Goal #3
Weight Loss
Weight Gain
Eat Better
Gain Strength
Improve Flexibility
Improve Top Speed
Improve Acceleration
Improve Endurance
Improve Form/Technique For Lifting
Decrease Reaction Time
Improve Balance
Improve Agility
Other
If
Other Please Specify
What
equipment, if any, do you have available to you?
Select Available
Equipment
Cardiovascular
Weights
Resistance Tubing
Power Squat Rack
Bumper Plates
Plyometric Hurdles
Balance (Stability) Ball
Other or Combination
If
Other or Combination,
How
many days can you HONESTLY
commit to an exercise routine?
Select Number of Days
2 Days
3 Days
4 Days
5 Days
6 Days
How
much time can you devote to
each exercise session?
Select Time Per
Session
30-45 Minutes
1 Hour
1.5 Hours
2 Hours
Please describe any other
specific goals or performances you wish to improve.
