New client — get STRONG with JLONG

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Let’s work together.

Share some info below to get your first free intro session scheduled!

Name *

First Name

Last Name

Email *

Phone

(###)

###

####

Age

Describe any injuries or exercise limitations: *

What do you do for a living?

What is your current exercise frequency?

How would you rate your level of non-exercise physical activity?

How would you rate your average level of stress?

Rate the following statements:

Healthy eating is a regular habit of mine.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I generally enjoy exercising.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I struggle to find time for exercise and eating well.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I haven't found a style/format of workout that I gravitate toward.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

My health is a priority.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I get enough sleep.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Which of the following describes your fitness goal(s):

Health (physical & mental)

Mobility

Endurance/cardio fitness

Strength

Increased muscle mass

Fat loss/toning

Training for specific event

Describe your preferred day(s) and time(s) to train.

What services are you interested in?

Personal training/small group fitness

Nutrition coaching

Not sure yet

What is motivating you to take this step toward better health?

Anything else?

Thank you!

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