Form - Pharmacy Athlete

Name *

First

Last

Phone

Email *

1. Tell me a little bit about yourself? *

(Lets not be too serious, hey maybe I want to also be your friend ☺ )

2. What is your height?

3. What is your current weight?

4. What is your current % body fat?

An estimate is fine

5. What limitations do you have? (if any) *

(ex. Could only workout in evenings or mornings, a health condition etc.)

6. What supplements are you taking, if any? *

7. What are your short and long-term fitness goals? *

8. Are you training consistently? *

9. Please tell me a little bit about your training program? *

10. What training programs have you tried in the past? *

Has it work? Yes or No? If no, what didn’t you like about it?

11. Have you ever tried any of the following diets?

12. Are you currently a gym member?

13. Any food allergies or dietary restrictions? Please list. *

14. Any injuries or other physical health conditions I should know about? *

What monthly coaching plan are you most interested in?*

15. What caught your attention to sign-up or how did you hear about us?

Anything additional you want to include? *