Fitness Profile

Take the first step to a new you, and fill out the form below.

Please complete this fitness profile with your most recent health/goal information to assist us in customizing the best fitness program for you. You will be contacted by one of our professional trainers for a free consultation within 48 hours. All information will be kept strictly confidential.

NOTE: If you register (click Create New Account) on the site, you can maintain this information on the My Account page before you submit this profile. You will only be contacted by a trainer if you sumbit this Fitness Profile form.

First Name: *

Last Name: *

Site Username (if logged in):

(This entry cannot be changed)

Contact E-mail: *

Home/Main Phone: *

Your home/primary contact number (no dashes please)

Work Phone:

Your office phone number (no dashes please) - indicate an extension with an x before the number.

Cell Phone:

Your cell phone number (leave out the dashes please)

Address:

City: *

State: *

State (2-letter state code)

Zip Code:

Age:

Height: as feet'inches"

Weight:

Overall Health: *

Tell us about your current health statys

Health Notes: *

A short description of any special health issues/concerns you may have

Fitness Goals: *

Describe your personal fitness goals (such as goal weight, strength, abilities)

Programs of Interest: *

In-home Personal Training

In-office Personal Training

In-gym Personal Training

Fit Camp (Boot Camp)

Private studio training

Ladies Club 4 Fitness

Aerobic Pole Dancing

CONTEST: Weight Loss Challenge 2011

CONTEST: Over-40 Fab Ab Contest 2011

Which programs are you interested in (you may select more than one)

Sessions per week: *

How many days per week would you like to participate in a fitness program

Days and times you are available:

Please indicate your availability and preferred days of the week/time of day you would like to be trained

Gym Equipment Owned:

Yes

No

Indicate if you own/use any gym equipment at home

How did you hear about us:

Radio advertisement

Radio guest appearance

Billboard ad

The Fit Squad car

Mailer

Flyer

Magazine article

Newspaper ad

Show/Event

Friend (specify below)

Other (specify below)

Please let us know how we reached you

Referred by:

Please let us know if another client or a business partner referred you

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