* 1. Please provide your FIRST NAME and the e-mail address or phone number that you can most easily be contacted at (If a phone number, also include best day/time to call):

* 2. Have you worked with a personal trainer before?

* 3. Why are you looking to work with a personal trainer?

* 4. How often would you like to meet with your trainer each week? (If you are not sure yet, you may note this).

* 5. On what days and times would you like to work with your trainer?(If flexible, please note)

* 6. How soon can you begin working with a personal trainer?

* 7. Where will you need to meet to train?

* 8. How far are you from Memorial Park?

* 9. How will you know if you want to work with a personal trainer if you haven't met them? (I have no idea!)

I provide a FREE 15-30 min initial consultation (over a cup of coffee-no workout clothes needed yet!) so that we can go over your goals in person and in greater detail. This way you can get a better feeling for whether or not I will be a good fit for you. Please submit THREE dates and times that would be best for you to meet (list preferred option first).

* 10. Do you have any concerns that you want to discuss in more detail at your initial consultation? (Include medications, health issues, age-related issues, life style concerns, etc. in this section OR write NONE)