Welcome to the first step in becoming your best self.

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YOU are unique, and we believe your Lifestyle, Fitness, and Nutrition Program should align with your specific needs, goals, limitations, schedule, and realities, to best support your success and longevity.

Please take the time to answer these questions with as much honesty and detail as possible. The more you're willing to share with us, the better it will allow us to understand where you currently sit in your journey so we can align our services appropriately to ensure you succeed.

How did you hear about us? *

Social Media

Google

Yelp

Friend/Word of mouth

Walk by/Storefront

Other

First name *

Last name *

Email *

Phone *

Date of birth *

YYYY

What goals are you seeking to achieve via our services? *

Increase overall health & wellbeing

Improve sleep

Improve nutritional practices

Improve overall lifestyle habits

Improve overall fitness levels

Improve strength

Improve flexibility

Improve endurance

Improve aesthetics

Increase energy levels

Finding alignment and balance with my realities and workouts

Becoming my best self

Other:

Required

Please explain what a typical day looks like for you (ie: wake time/sleep time, breakfast/lunch/dinner, work/career (day shift, night shift, swing shift, work from home...etc), stress levels, do you sit, drive, stand, move...etc., long hours, physical demands, sedentary....etc): *

Please describe your current eating routine/nutrition habits (How many meals per day do you consume? Are they whole food meals, shakes/smoothies, pre-made/pre-packaged, eating out/delivery, do you take into consideration the "what and why" you choose to consume for each meal?, etc...): *

Please describe your fitness/athletic history (any and all sports you've played since youth, any and all workout/fitness programs/routines/gyms you have tried/completed and how you felt about each them (loved, hated, indifferent...etc)): *

How many days per week do you feel your current lifestyle and realities will allow for your workout program/routine? *

Do you have any medical conditions we should be aware of? *

Yes

Medications that could impair your; motor skills, mental clarity, and/or emotional state?

Surgeries

Injuries

Hardware that could impact range of motion and/or movement mechanics

If you answered "Yes" to any of the items above, please provide detail:

Please tell us about your sleep habits (are you aware of your quality of sleep? how many hours do you sleep per night? do you feel your daily lifestyle habits currently support quality sleep?.....etc.): *

Please tell us about your hydration practice (are you aware of how much water you consume per day?, are there specific obstacles that you feel detour you from consuming water on a steady, consistent basis each day?, is consuming enough water challenging for you?...etc.) *

Are you interested in working with a specific coach? *

Emily Wicklund

Kara Nolley

Kelsey Garcia

Chad Franco

No preference

Please tell us where you prefer or plan to workout? *

"Onsite" at The C5 Facility

"Hybrid" (C5 Facility & at home or outdoors)

"Remote" (either another facility, or at home)

Other:

Required

Please tell us your current top 3 values/priorities in life that drive your daily decisions (ie: family, career, fitness/health.....etc.): *

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