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Gettin' to know You!

Please answer the following questions to help me learn a little more about you and how I can help you reach your fitness and nutrition goals.

First Name

Last Name

Cell Phone

Email Address

Date of Birth

What is the best way to reach you?

Phone

Text

Facebook message

What is the best time of day to reach you? *

Morning

Afternoon

Evening

Anytime

What is your address?

How did you hear about us?

Google

Facebook

Drive by

Referral

Other

What types of services are you interested in?

Group fitness classes in our studio at 577 Granby Road South Hadley

Virtual Fitness Classes-workout online with us

1-1 Coaching - Personal Fitness

Nutrition - Weight Management - Meal Planning

Accountability - Support

All of the above

Other

What are your goals for joining our programs and how can we help you achieve them?

Do you have any physical limitations or prior injuries that you think I should know about?

Are you currently exercising or following an exercise program? If so please describe: If no when was the last time you exercised?

Is there a type of workout you prefer or you would like to try?

Dance Fitness - Zumba

Yoga - Stretching Balance - Core

Strength Training - Using weights

Kids Fitness

Barre - Ballet - Pilates - Low Impacte 5

Chair Classes - senior fitness - beginners

Pound - Drumming Workout

Circuit Training - Hiit

Cardio Kick Boxing

Nutrition Support Group

Step - using a platform to music

Country Beat Fitness

Sunless spray tanning

Other

How many times a week are you willing to commit to exercising at leas 30 minutes and or to improving your overall health to rech your goals? This can be in studio or at home.

Are you currently following a nutrition program or have you followed a nutrition program in the past? If so please describe and share your experience, what did you like and / or dislike? *

Are you on social media? If so what platform do you have? *

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