Emergence Wellness New Client Intake
Congratulations! I am so excited that you are here and interested in working with me to take the next step get real fitness results. Together with hard work we will improve your body and boost your confidence. Online training is an amazing, efficient, and cost effective way to remodel your health and fitness and this form will help me to customize the best experience possible for you. The only drawback to online training is that we cannot physically work together each step of the way, so you and I both need to know that this is important and that your commitment to improving your health is going to be real so that no time, money or energy is wasted. There is nothing more gratifying than hitting your goals and feeling unstoppable. As soon as this is filled out, I will reach out via email and we will get this journey moving ! Thank you.
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Email Address *
Full Name *
Cell Number *
Favorite Bond Actor? *
Height *
Current Weight *
Heaviest Weight *
Lightest Weight *
Which program are you most interested in? *
What is your current fitness goal? *
Are you willing to change some lifestyle habits to achieve your goals *
Nope, Just want to work out
100% Committed to Change
Do you have hobbies, sports, other interest that you enjoy in your off time? *
Do you work? If yes, what is your occupation? *
Are you willing to spend $200-$350 per month to look better, feel better and hit your fitness goals? *
Have you ever performed a strength training routine before? *
Have you ever worked with a personal trainer before? *
Do you have any past sport experience? *
If yes to above, which sport and how long did you compete?
Do you have any surgeries, injuries or little annoying things (not bad drivers) that bother you that I should know about while considering your program? *
How many hours a week are you willing to put into your routine to achieve the body you desire? *
Do you have access to a gym?
Clear selection
If you do not have access to a gym and are unwilling to join one, that is totally fine. We can make great gains at home or outside. However will you be willing to purchase about $100 worth of bands and other equipment? *
How exited are you to begin the program? *
Hell Yes, Lets Start Right NOW!
Let's Start Next Monday
Have you ever gone on a diet before? *
If yes, then which one and did it work?
Would you rather eat... (sweedish fish are my personal fav) *
How often do you get 6-8 hours of sleep? *
That should do it for now, I thank you for taking the time to help me learn a little about you. There is much more to come as we work together, but if there is anything else you want me to know please fire away below. *
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