WPT Personal Fitness Success Form

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Welcome to the Willis Performance Training success form page. This form is our way of getting to know a little bit more about you, get a little deeper information about your goals, and determine our program is a good fit for you. The form should only take 5-7 minutes to complete.

After you are finished with the form and submit, your coach will be in touch with you.

Thank you and we absolutely look forward working with you!

Email *

First Name *

Last Name *

Gender *

Male

Female

Age *

Height *

Weight *

Phone Number *

Email *

Occupation *

What is your favorite music group of all time? *

How did you hear about us? *

Can you briefly describe what your short term goals would be in the next 3-6 months? *

What is your MAIN reason for wanting to achieve these goals? *

What is your favorite food? *

Do you have any dieting restrictions? *

Yes

If you answered yes above, briefly tell us a bit more

On a scale of 1-10, how would you rate your current eating habits? *

Bad

Great

How would you describe your current lifestyle? *

Extremely Active. I hate to sit around and do nothing

Decently active. I participate in recreational activities but nothing too intense

Not really that active. I might workout on occasion but not consistently

Not active at all. I know I need to be but don't make or have time for it

Are you currently following an exercise program? *

Yes

Not Sure

If so, please briefly describe below

How would you describe your current level of fitness? *

Do you have any previous injuries, nagging pains, surgeries, or any type of restrictions that we should know about? If so please tell us more below *

What is your favorite vacation destination? *

How do you feel our coaching is a good fit to help you achieve your fitness and health goals? *

How much are you willing to invest in reaching your health and fitness goals? *

$200-$300

$301-$500

$400-$600

On a scale of 1-10, how ready are you to get started within the next 7 days on your custom program and commit a full 100 percent? *

Not Ready At ALL

I am ready right now!!

Is there anyone else other than you who may be involved in your decision to begin a training program? *

Nope just me

Yes

When is the best time to contact you? *

Early Morning

Late Morning

Early Afternoon

Evening

Send me a copy of my responses.

Submit

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