Free Consulation – Sam Muldoon Coaching

Name*

Email*

Phone Number*

Height*

Simply enter the number for your height in feet and inches, separated by a space. Ex. 5 6 for 5′6".

Weight*

Simply enter the number of your weight (in lbs). Ex. 170 for 170 lbs.

What motivated you to try out online personal training with me?*

Do you have any medical concerns?*

Do you currently take any medications? If so, list them below. Type “N/A” if this does not apply to you.*

Do you currently take any supplements? If so, list them below. Type “N/A” if this does not apply to you.*

What is your background in fitness? (previous sports history, how long you’ve been working out and at what level, any breaks you’ve had, etc.) *

What are your current goals, and what are you hoping to achieve (weight loss/gain, strength gain, overall health, athletic performance, etc.)? *

What are you currently doing to achieve the goals listed above? Be detailed. (If nothing type N/A)*

Have you attempted to reach these goals before? If you have, why do you think you didn’t reach/sustain them? (if this doesn’t apply to you, type N/A) *

Additional Comments (Optional)

How would you describe your current level of fitness?*

Beginner

Intermediate

Advanced

Other

How many days a week do you exercise NOW?*

1-2 days

3-4 days

5-7 days

Other

How many days a week can you dedicate towards exercise in the FUTURE?*

1-2 days

3-4 days

5-7 days

Other

What time of day do you prefer to workout?*

Morning

Afternoon

Evening

Other

What workout equipment do you currently have access to? List ANY and ALL.*

Are there any particular exercises that have caused trouble in the past?*

Are you ready to take the first step in achieving your fitness goals and schedule a consultation?*

Yes

Lets Schedule Your Free Consultation!