Customized Workout Plan

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

First Name *

Last Name *

Instagram username *

Did someone (other than Dom or Erik) refer you to this form? (If so, please list their name below)

Age (Include your birthday) *

Height *

Current Weight *

Goal weight (if applicable)

I am looking to: *

(Choose all that apply)

Lose weight

Gain weight

Maintain weight

Gain Muscle

Other:

Required

What's your job? *

Describe your daily activities *

Sedentary (Spend most of the day sitting: bank teller, desk job)

Light Activity (Spend a good part of the day on your feet (teacher, salesman)

Moderate Activity (Spend a good part of the day doing physical activity: waitress, mailman)

Very Active (Spend a good part of the day doing heavy physical activity: construction, carpenter)

What workouts do you currently do? *

Please describe the type of workouts, duration, and how often you workout per week.

What type of workouts do you ENJOY the most? *

What workout are you most interested in trying? Are you just a weightlifter? Do you want all cardio? Are you more of a dancing queen/king? Do you love group fitness classes? How about low impact? Or maybe a mix of everything? Describe what kind of workout you would love to do.

Is there a specific area of your body that you'd like to focus on?

What is your preferred duration of workouts? *

30 min or less

30 min - 1 hour

1 hour or more

No preference

Other:

I will be doing my workouts... *

at home

at a gym

combination of both

Other:

I will have access to the following (Check all that apply) *

Gym (Dumbbells, Machines, etc.)

Dumbbells/Kettlebells (from home)

No equipment- all body weight exercises

Other:

Required

If you are doing your workouts at home, please list below what equipment you have

(If you have access to a gym, please let us know which gym)

How many days per week can you workout? *

Have you been coached by us before? *

Yes

Have you used our Workout App before? *

Yes

When obstacles arise, what will be your WHY to keep going and not give up? What's your reason for beginning and enduring this journey? *

We don't believe in quick fixes and sacrificing long-term health for short-term results. We will be giving you the tools, mindset, and support to implement lifelong healthy habits that will require patience, self-care, and continual progress (NOT perfection). Are you ready to begin? *

Yes

YOU get to 'Name Your Price' *

How much can you afford each month?

Any questions for us? *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms