Video Training Subscription Quote

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Contact Information
Please complete the form below to get started. Make sure your email is current. We will email you at the address you provide with the next steps to complete your Video Training Subscription quote request.
Name*
First Last
Email*
Phone*

Health and Fitness History
The following information is requested for your health and safety as well as our information so that we can design the most effective fitness plan for you. All information is required. Your information will be kept private and confidential.
Please list all PAST and/or CURRENT medical conditions, injuries, surgeries, broken bones, C-section, etc. If you're not sure, please include:*
List all current medications or supplements:*
When was the last time you worked out?*
What did your workout consist of?
Describe one day of typical food intake:*
Fitness Goals
What is your goal?*
How many days a week can you dedicate to Personal Fitness Training?*

Video Training Subscriptions
Pricing will be determined upon consultation. Submitting this form does not obligate you in any way. We do not collect payment information at this time. We respect your privacy; your information will be held in the strictest confidence.
What is the best day to reach you?*
Date Format: MM slash DD slash YYYY
What is the best time to reach you?*

: HH

MM
How do you prefer we contact you?
- Email
- Phone

Contact Information