Name *

First Name

Last Name

Phone ( Country code is +01 for USA) *

Country

(###)

###

####

What kind of program(s) are you interested in? *

Please select any/all applicable

Pregnancy & Postpartum

Corrective Exercise

General (Strength/Fat Loss/ Nutrition)

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *

Yes

No

Do you feel pain in your chest when you perform physical activity? *

Yes

No

In the past month, have you had chest pain when you were not performing any physical activity? *

Yes

No

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Yes

No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes

No

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *

Yes

No

Do you know of any other reason why you should not engage in physical activity? *

Yes

No

Depending on the package/program you select, pricing will vary but generally expect to budget about $300/month. On average, most clients are with me for 9 months. How much are you willing to invest to reach your goals? (select any/all) *

$200-300/m

$300-500/m

$500+/m

How did you hear about A1 Fit Coaching? *

IG

FB

YouTube

Ascent PT

Client Referral

Other

Please read & agree to the liability & waivers & Terms and Conditions linked below *

c/p this URL into your browser to review: https://drive.google.com/file/d/1sFoCmasL7_sN_TImiYlTw_j97VbVJa05/view?usp=sharing

I agree to the Liability & Waivers & Terms and Conditions linked below.