Intake Form

Welcome to our IGym Lifestyle (IGL) Application Form. Thank you for your interest in our program. Please answer every question completely.
It is important to remember that this program explores our mind and our lives through exercise. This is also a personal training course. We will be physically training you as well. This program will be fuses premiere exercise training regimen with group discussions and motivational strategies for engaging in a "whole health" perspective and lifestyle. Thanks again for your interest.

Best,
The Internal Gym Team

Question Title

* 1. General Information

Question Title

* 2. Evaluate the following reasons for wanting to enroll in The IGYM Lifestyle Program:

  Strongly Disagree Disagree Neither Disagree Nor Agree Agree Strongly Agree
I have a desire to learn to ways to combat mental limitation in life and in the gym.
I suffer from negative thinking and it prevents me from achieving my goals
I’ve hit a mental plateau
I’ve hit a physical plateau
I don’t have the motivation to stick to a program long enough to see results
I want the perfect body to show others
I’m insecure about my body
I seriously want to make lifestyle changes in my life and believe I am ready to stick to them
I'm generally dissatisfied with where my life is
I know I'm capable of so much more and want to tap into that
I like the idea of a holistic approach to exercise

Question Title

* 3. What motivated you to want to apply for this program?

Question Title

* 4. What prior experience do you have when it comes to exercise and nutrition?

Question Title

* 5. What prior experience do you have when it comes to self development courses programs or coaches?

Question Title

* 6. How serious are you about making the changes necessary to have the body you want and the mindset required to achieve it?

0 10
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 7. I am currently willing to invest my energy, time and money in a program that provides exercise training and education and self development training and education?

0 10
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 9. Describe your prior experience with life coaching of any sort (ie. Self-development books, a mentor, a life coach, retreats)?

Question Title

* 10. If you answered yes, how helpful (or not) were these experiences?

Question Title

* 11. In your own words what are your biggest obstacles when it comes to your health and over all well-being

Question Title

* 12. What are your primary goals for taking this program? What are you most excited about learning?

Question Title

* 13. Anything else that you’d like to share? 

Question Title

* 16. Are you willing to meet once weekly for the lifestyle and motivation component of this course.

T