Checkout Your cart is empty. Initial Consultation Questionnaire If you are a human and are seeing this field, please leave it blank. First Name Last Name Email Do you have a high speed internet connection? Yes No Skype User Name Phone Male Female Sex Age Height Approximate Weight Do you have any physical limitations or medical conditions that need to be addressed before starting an exercise program? Yes No What are your goals? Lose Body FatToneGain StrengthAdd MuscleIncrease FlexibilityLearn YogaStart a Meditation PracticeIncrease Cardiovascular EnduranceLearn Better Nutrition HabitsOverall FitnessTrain For an Athletic EventLearn KettlebellsLearn Olympic/Power Lifting TechniquesCompete in a Bodybuilding or Fitness Competition Your eating habits are: Poor Good Excellent Your diet consists of: FruitsVegetablesNutsBreads, Grains, CerealsDairyEggsFishMeatssweetsFast FoodAlcohol Check all the times you regularly eat: Before 6am6am7am8am9am10am11am12am1pm2pm3pm4pm5pm6pm7pm9pm10pm11pm12pmAfter 12pm Are you currently exercising? Yes No How many days do you currently exercise per week? Zero One Two Three Four Five Six Seven What activities do you currently participate in? Strength TrainingCardio/AerobicsCalisthenicsYogaOrganized SportActivity Based FitnessMeditationNone/Other What new activities are you interesting in trying? Strength TrainingCardio/AerobicsCalisthenicsYogaOrganized SportActivity Based FitnessMeditationOther What factors do you foresee to be the most challenging obstacles to overcome? TimeMotivationCommitmentDesireUrgency/Need Please list ideal days and times for your consultation to be scheduled?