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CLIENT QUESTIONNAIRE
MALE
FEMALE
how can I help you?
Weight Loss
Build Muscle
Healthy Lifestyle
wHAT IS YOUR MOTIVATION TO START NOW?
WHY DO YOU BELIEVE YOU'RE A GOOD FIT FOR THIS PROGRAM?
ARE YOU WILLING TO INVEST $7 - $9 DOLLARS PER DAY INTO YOUR HEALTH AND WELLNESS?
IS THERE ANY ADDITIONAL INFORMATION THAT YOU WOULD LIKE TO SHARE WITH ME OR COMMENT?
TImeline for achieving your goal.
90 Days
16 Wks
24 Wks
32 Wks
40 Wks
1 Year
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Thank you! Your submission has been received!
I will contact you shortly.
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