Free Consultation Form
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Email *
Full name
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Phone Number *
Address *
Birthday date *
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Gender *
Height *
Weight *
Has your doctor ever told you that you have any of the following: *
*Do you feel pain in your chest during physical activity or at any other time? *
Are there any other reasons that you should not perform, or limitations that could prevent you from performing physical activity? *
If yes, please describe:
Do you have any existing injuries? Or any muscle, tendon, ligament, bone or joint problems that will be exacerbated by increase in activity? *
If yes, please describe:
Are you currently pregnant? *
Are you currently taking any medications or supplements that may affect your heart rate or blood pressure? *
If you answer yes to the above question, please list:
Acknowledgement
I acknowledge and agree that it is my responsibility to disclose any such prescribed medications. I further acknowledge and agree that if I answer yes to any of the above questions that are noted with an asterisk (*), staff of the facility may require that I provide written physician approval before I may use or participate in any physical activity conducted in the facility. I understand that it is my complete right to decrease or stop any use of or physical activity in the facility and that it is my obligation to inform the facility staff of any symptoms or other medical issues should any develop.

Have you been to Total Fit Studio before? *
How did you hear about us? *
Do you currently exercise? *
If yes, what are you currently doing for exercise?
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What is your current activity level? *
If none, when was the last time you workout?
How are you doing with Nutrition? *
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How much water do you drink during the day? *
What are your health & fitness goals? *
Do you feel happy with the way you look and feel and your health? *
Share specific goals we will help you achieve: *
Why are these important to you? *
How long have you been thinking about achieving these goals? *
On a scale of 1-10 how serious are you about achieving your goals? *
What barriers have you had in reaching your fitness goals? Are any of these berries still present?
Have you ever used personal training in the past? *
If yes, how was your experience?
What kind of help are you looking for right now?  *
What days/times do you anticipate that you’ll be using the studio?
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Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Early morning (6 to 9 am)
Mid morning (9 to 12pm)
Afternoon (12 to 4pm)
Evening (4 to 7pm)
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