Personal Training Interest Form

Name *

First

Last

Phone Number *

Email *

Instagram

Date of Birth *

Current Age: *

What's on your mind right now regarding your health? (e.g. losing weight, fixing your diet, food cravings, boosting energy, etc.) *

What have you tried to improve the issue you mentioned in the previous question? (e.g. followed a certain diet, took a certain supplement or medication, tried a specific type of workout plan, etc.) *

Which of the following health professionals have you worked with in the past, or are you working with right now? (Check all that apply) *

If you answered "Other" to the question above, what is the other option you've tried?

What would you ideal fitness result be in 3 months? What would your dream be? *

Be 100% honest - What is stopping you from reaching this dream result? *

If a trusted friend advised me to invest $3,000 on fitness coaching that would guarantee my dream goal would come true, I would.. *

Jump on the opportunity - I would be so excited to finally have that dream become my reality
Be nervous but excited. I know I'll have to step out of my comfort zone to achieve my dream results
See this as too big of a risk. My goal would be great to reach, but I'll survive if I don't get there

If you could get one thing out of our call to make it an absolute win for you, what would it be? *

When are you looking to start making some changes to move your towards your goal? *

Immediately
Within a few months
Not sure

If you were thinking about starting a new plan that would move you towards your goal, is this a decision you'd make on your own? *

Yes - I make decisions like this on my own
No - I like to consult with my spouse/partner before making decisions like this

I sent you some quick training that will be relevant to you. Will you have 15-20 minutes to watch this before our call? *

Yes - I will watch it
No - I will not have time

Thank you for completing the application!

After you click the Submit button below, you will have the option to schedule a phone where we will discuss your goals, our expectations, and figure out if we're a good fit to work together.

If you have any problems scheduling your appointment, please email me at jon@empiricalfitnessgym.com
or text me, (512) 296-5677.