In-Home Programming Questionaire

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99 Barbell In-Home Personalized Programming Questionnaire
Please fill out our questionnaire and one of our certified professional will contact you to get started!

* Indicates required field

How did you hear about us? *

Internet Search Facebook Instagram Other

If Other please specify: *

What is your age? *

18-25 26-35 36-45 46-55 56-65 66+

What is your top goal? *

Lose Weight Get Strong Stay Active Get Lean ALL OF THE ABOVE!

Can you commit to working out at least 3 times a week for at least 30 min? *

Yes No, but I will try

Are you coachable and willing to apply our coaching methods consistently? *

Yes I'm No, but I'm willing to try

What type of training and nutrition have you tried in the past? *

Cardio only programs (Spin, kickboxing, Zumba, Aerobics...etc) Diet only programs (Weight Watchers, Jenny Craig, NutriSystems...etc) Resistance Training (Weights, barbells, dumbbells...etc) All of the above

Check all that applies!

What has stopped you from achieving your goals in the past? Check all that applies! *

Motivation Accountability I don't know how to workout properly I don't know why I don't know

Do you have any current or past injuries or surgeries that we should be aware of? *

Please make sure to include this! This is vital information that will help us pair you with the right trainer.

On a scale of 1-10, how committed are you to achieving your goals? 1 being "eh, whatever" and 10 being "nothing will stop me" *

What would you like to receive from our Program? *

Change in strength and physique in the fastest and safest way possible Support and guidance from an experienced coach A customized plan created and adjusted weekly for my specific body All of the above!

Are you ready to commit to starting and investing in your health and fitness goals? *

Yes No

What is your First and Last name? *

What is the best email address for you? *

I'm Ready to Start!

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