New Orleans Personal Trainer Request Form

* Name

* Email

If you would like us to contact you by phone, please enter it here:

Age

* Subject (select) Personal Training Request

* What are your life goals for mind?

* What are your life goals for body?

* What are your life goals for spirit?

* Why do you want to accomplish these goals?

* Have you accomplished any of your goals?

If Yes, please select which ones:

If No, are you willing to make the commitment to changing your life and health?

* Do you feel anxious about your decision?

* Do you enjoy the outdoors?

If yes, what outdoors activities?

* Do you enjoy exercising?

If you answered no, please explain.

* What time would you consider the “ideal” time for you to workout?

* Do you travel frequently?

* If yes, is it job related or pleasure?

* On an average, how often weekly,monthly,annually?

* Do you enjoy reading?

If yes, what is your favorite category?

What are your hobbies?

* What is your “bad" food?

* Is there any particular food that just absolutely controls you?

* Have you been on a diet before?

If yes, which diet (s) and how long since your last diet?

Did you believe it was an effective diet?

How many pounds did you lose?

How long did you maintain the weight loss?

* How often do you eat out?

What meals do you typically eat out?

If you eat dinner out, is it generally a late dinner?

* Do you typically have dessert when you eat out?

* Verify