Health & Fitness Survey Health & Fitness Survey Intake Form Standard Contact Information, Vertical Name* First Last Email* Phone*I am interested in:* Small Group Training Personal Training Both Small Group Training and Personal Training What are your goals in the next 3 to 6 Months? : (Check all that apply)* Weight Loss Get Toned (lose fat and build muscle) More Energy Better Health Other Other: On Scale of 1-10, how serious are you about reaching your health goals?*Please enter a number from 1 to 10.I will be working out: (Check all the apply)* Weekday Mornings Weekday Evenings Weekend Mornings When are you looking to get started on your journey to a healthier life?* CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
