JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Sign Up Sheet (Virtual Personal Training)
If you are serious about working with me and you are ready to take the next step towards a healthier balanced lifestyle, fill out the application below.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First and last name
*
Your answer
Phone number
*
Your answer
Address
*
Your answer
Gender
*
Choose
Male
Female
Age
*
Your answer
Height (Feet/Inches)
*
Your answer
Weight (Lbs)
*
Your answer
Occupation
*
Your answer
What is your main goal at this time?
Fat loss
Muscle gain/definition
Increase strength
Creating a healthy lifestyle & mindset
Other
Clear selection
List 1-2 long term goals (4-6 months)
Your answer
How would you feel if you accomplished your goals?
Your answer
Do you currently exercise?
Choose
Yes
No
Once in a while
Briefly explain your eating habits
Your answer
Do you have any experience tracking macros?
Choose
Yes
No
I've heard of it
If you are tracking macros, what are they? (Ex. Grams of protein, carbs, fat, calories). How long have you been in a caloric surplus or deficit? What is your experience with tracking?
Your answer
What are you looking for in a coach? Have you worked with a coach before? If so, how was your experience?
Your answer
Why are you committed to working with me at this time?
*
Your answer
Anything I should be aware of?
Your answer
What days work best for you?
*
Tuesday
Wednesday
Thursday
Friday
Saturday
Required
What times work best for you?
*
6am
7am
8am
9am
10am
11am
Other
Required
Add any additional information about your schedule here
Your answer
How did you hear about JessCFit?
*
Facebook
Instagram
Google
A friend
Other
Which package are you signing up for?
*
1 Session = $45 (Valid for 30 days)
(1 Month) 1/Week = $140/month (Valid for 30 days)
(1 Month) 2/Week = $280/month (Valid for 30 days)
(1 Month) 3/Week = $420/month (Valid for 30 days)
(1 Month) 4/Week = $560/month (Valid for 30 days)
( 2 Month+) 1/Week = $130/month (Valid for 60 days)
( 2 Month+) 2/Week = $260/month (Valid for 60 days)
( 2 Month+) 3/Week = $390/month (Valid for 60 days)
( 2 Month+) 4/Week = $520/month (Valid for 60 days)
Would you like to discuss nutritional coaching?
*
Yes
No
How would you like to pay?
*
E-transfer
Credit + (2.9%+$0.30)
Any other questions/things to add?
Your answer
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
