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Mission & Vision
About
Services
Fitness
Nutrition Therapy
Neuro/Z-Health
Yoga
Emotional Freedom Experience
Offerings
MIT Workouts
Books
Recipes
Let’s Connect
Exercise History
Fill out the form below.
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Name
*
First
Last
Email
*
Were you involved in athletics growing up?
Yes
No
If yes, please describe:
Have you ever suffer a serious injury due to athletics or exercise?
Yes
No
If yes, please describe:
Do you have any physical disabilities that inhibit your ability for movement?
Yes
No
If yes, please describe:
Do you see a chiropractor, manual or physical therapist, acupuncturist, or the like for any physical chronic pain, injuries or discomfort?
Yes
No
If yes, please describe:
Are you involved in competitive or intramural athletics currently?
Yes
No
If yes, please describe:
Are you currently involved in an exercise program?
Yes
No
If yes, please describe:
Have you ever worked with a personal fitness trainer?
Yes
No
If yes, was it effective? Please explain.
Do you like working out?
Yes
No
If no, what are the greatest limiting factors to your enjoying working out?
What are your goals for exercising?
Weight Loss
More Energy
Muscle Gain
Sports/Event Training
Lifestyle Change
Health Improvement
Coordination
Stress Reduction
Other
How much time do you have to dedicate to exercise?
How motivated are you to exercise on your own if given the proper training and tools?
What are your goals for working with a personal trainer/nutrition therapist?
Thank you for taking the first step in reaching your goals!
Submit
Below are the forms needed for client participation.
Client Questionnaire
Personal Health History
Consent & Disclaimer
