Consultation “Get To Know You” Survey Question Title * 1. Please fill out the following: First and Last Name Email Address Phone Number Question Title * 2. Which best describes your overall fitness/health goals? Fat Loss Muscle Gain General Health/Maintenance Performance Based/Sports Performance Other, or a combination of the above options (please specify) Question Title * 3. What are your health/fitness goals? They can be short term, long term, general, or specific – and it does not have to be number related!! (Ex. “I want to be able to run a 5k by 2022” vs. “I want to lose 30 lbs.”) Question Title * 4. Do you have any dietary restrictions and/or preferences? Question Title * 5. Do you have any past experience with other programs, diets, coaches, etc? Question Title * 6. What, if anything, do you think has prevented you from reaching your goals/motivating you in the past? Question Title * 7. Are you also looking for fitness options/personal training? Yes - I am new! I need help with getting started Yes - Help with accessory work to add on to what I am currently doing to reach a specific goal Yes - Help with building strength Yes - Personal programming Yes - But not sure what Not at this time Question Title * 8. How did you hear about us? Instagram (OPB Nutrition) Instagram (itsthegym_notarunway) Facebook Family/Friend Search/Google Other (please specify) All Done!