First & Last Name:

Email Address:

Telephone Number:


Height (inches):

Weight (lbs.):

Your Physical Activity:

Has your doctor informed you that you have a heart condition or recommended only medically supervised physical activity?

Any chest pains during physical activity or while not doing physical activity?
If yes, please explain.

Any loss of balance due to dizziness?

Any joint issues causing discomfort?

Do you smoke?

Do you drink? If so, how many days a week?

Is your job sedentary or active?

Do you have any physical restrictions?

Do you have any equipment that can be used during training?
If so, what equipment do you have available to use during our session(s)?

What is your main goal? (i.e. weight loss, muscle gain, define/tone/decrease body fat, etc.)

What three areas would you like to focus on?

What video chat do you have access to?

Please list your preferred times and dates you are available for your workout session.
I will notify you before I reach out to you via email to confirm your time.

For multiple sessions purchased: How many times a week would you like to train?
What days and times are you available to train?

Contact Us

We're not around right now. But you can send us an email and we'll get back to you, asap.