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Full Name *
Preferred Number *
Fax Number
What number will you be calling me from
Mailing Address
Preferred Email Address *
List if you have Microsoft Word and/or Excel on your computer
Do you wish to send and receive text message with this cell number
Age
Female or Male
What is your Exact Goal or Goals
Do you have a goal deadline and what is it
How many TOTAL months of weight lifting experience do you have
What is your clothing size on top and what do you want it to be
What is you clothing size on bottom and what do you want it to be
Did or do you play any sports and what are they
Do you have any injuries and if so describe in detail
Have you been working out recently and if not, tell me how long ago you were working out consistently (consistency is a minimum of 3 consecutive months)
Enter all the exercises you can remember doing and the maximum amount of  weight you know you HAVE performed with those particular exercises
Do you have any medical conditions that may harm you when performing a fitness routine and if so describe each one
Will you consult with your physician about your workout, cardio plan, and diet plan before starting it and if so have any of the above professionals advised you not to engage in this program
Height and Weight
Desired Weight
Comments
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