Consultation Interest Form to Functionally Fit

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You made it here because you are looking for a different approach to make your fitness results last a lifetime with efforts that fit into your busy work and family schedules. Functionally Fit Custom Fitness is dedicated to helping men and women transform their bodies and their lifestyle with custom designed, age-appropriate fitness training and nutrition programs.
Please fill out the application below, and we'll contact you within 24 hours to see if you are a good fit for our programs.

Thank you again, I look forward to helping you get back to fitness and improve your health.

Email *

Name *

Cell Phone

How Did Find Us? *

Client Referral

Website/ Google

Facebook

Flyer/News letter promotion

Other:

What kind of program are you most interested in learning about *

In Studio Individual or Semi-Private Personal trainingh

In-Home Individual or Semi-Private Personal Training.

Online Nutrition Coaching/ Weight Loss/ Lifestyle Coaching-

Other:

For Interest in IN-HOME Personal training from above. Are you local (within 10 miles of Glenview and Deerfield IL?)

Yes

Maybe

Other:

In General, What Are Your Goals? check all that apply *

Lose weight/ fat (Change in Girth Measurements)

Improve physical fitness (Weight control is not the main priority)

Need Help Get Started from a very low fitness level with joint and mobility issues.

Get Stronger- Improve muscle mass, bone density, muscular endurance.

Improve athletic performance for recreational or high school level sports- Power, Speed, Agility, Level I or II nutition)

Feel better- have more energy- manage stress or lifestyle habits (level I nutrition, Exercise basics to improve energy.)

Learn the basics of quality Nutrition Guidance (Level I, Level II, or Level III)

Physique competition/ modeling (Level III nutrition guidance, strict workout and nutrition schedules in a specific time frame)

Other:

Do you have a timeline for reaching that goal?

3. On a scale of 1-10 how do your feel about your body right now? (10 being you would run down the street naked.) *

4. On a scale of 1-10 what are your energy levels right now? (1 being you can't get out of bed.) *

6. What qualities are you looking for in a Custom Fitness Program? *

Keep me motivated to exercise/ Renew or Refine Exercise training techniques and form/ bring me to a more advanced level of fitness

Need my ass kicked to complete my workouts. Training for a sport performance.

Solutions to nutritional habits and maintaining self accountability

Finding Sustainable weight loss and toning my body.

Easy to follow meal mapping guides that allows me to enjoy my favorite foods

Non-intimidating environment

7. Have you ever worked with a fitness coach before? *

YES

Required

8. If "Yes" from #7. How Did that Work For You?

What kind of schedule are you looking to become committed to within your current lifestyle to meet with your coach?

Low commitment- a few training sessions per month.

Medium commitment- 1-2 training sessions per week.

High commitment - 3 or more sessions per week until I reach my goals.

Nutrition coaching only

Clear selection

Why are you wanting to get back into shape and get your health back on track? Why Now? *

What are the biggest challenges you have in reaching your fitness goals? *

What is your current fitness level and knowledge of exercise training, and resistance with weights? *

Any medical considerations or Orthopedic limitations I need to know about and consider while customizing your fitness plan?

The best Date and Time to call you for your introduction and consultation. Time needed for a call is about 15-20 minutes.. sometimes longer.

YYYY

Time

Do you have any questions or concerns about beginning a fitness or nutrition change program with coach Vickie Jo Frego of Functionally Fit Custom Fitness?

Thank You!

Thank you for your time. Remember, there is no one-size-fits-all approach to fitness success. With Custom Fitness Coaching from Functionally Fit, you will break through your barriers with a program that is personalized for you as an individual. Vickie Jo Frego will contact you as soon as she assess your document. In the meantime, please visit our web page
www.functionally-fit.com

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