Ultimate Transformation Assessment Form

Name*
First Last
Age*
Sex*
- Male
- Female
City, State, Zip*
Phone*
Email*
How did you hear about this program?*
Current Weight*
Desired Weight*
In your opinion, where are you on this scale? Lean( 1 2 3 4 5 6 7 8 9 10 )Fat*
What would you describe yourself to be?*
- Active
- Sedentary
Are you currently involved in an exercise routine? Explain:*
When was the last time you exercised?*
What are your goals from your fitness program?*
What is your commitment level at this point to begin creating and implementing a routine to achieve your goals? Hemming and Hawing( 1 2 3 4 5 6 7 8 9 10 )I’m Ready!*
Do you have any health concerns or problems that may restrict you from exercising?*
What services do you expect?*
What do you want to look and feel like?*
What’s your single biggest challenge right now? Please be detailed, not vague including any details.*
Why should you be given a spot on the Program?*
Are you willing to invest in yourself to get the body, health and results you want?*
- Yes
- I'm on a budget, $50 a week would be MAX
- No
Are you 100% willing to commit your FULL effort to this training program?*
- Yes
- No
Additional information you would like to provide:
Comments
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