PT Distinction

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Name *

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Email *

Phone Number *

Age *

Height *

Weight *

Estimated body fat *

Gender *

Who is your favorite superhero? *

Have you had a coach before *

Brief Health History - knees, back, hips? *

Training History - what have you done before or doing now? *

Three month goals *

Nutrition Restrictions *

Worst exercise ever ? *

On a scale of 1-10 how committed are you to achieving your goals *

Are you will to invest $200 - $400 *

Why do you think I can help you *

Is there anyone else who may be involved in your decision to hire a coach or stick to a fitness program *

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