Name *

First Name

Last Name

What time of day do you plan to workout? *

Early morning (5-8a)

Mid morning (8a - 12p)

Evening (4-6p)

Other

Are you able to commit to working out twice a week? *

Yes

No

Are you in good general condition? *

Yes

No

Unsure

Have you struggled to lose weight in the past? *

Yes

No

Have you struggled with maintaining a self-directed fitness program in the past? *

Yes

No

Have you worked with a personal trainer before? *

Yes

No

Is it more important that you accomplish your goal quickly or permanently? *

Quickly

Permanently

Do you want to sustain your goal after you achieve it? *

Yes

No

Can you make a financial decision without your spouse's input? *

Yes

No