Intake-Questionnaire | PT Pods Private Gyms

First name

Last name

Email

Phone

What brings you here today?

What is your current fitness situation?

I'm overweight and tired all the time.

I exercise but I'm not getting the results I want.

I’ve never been into fitness and don’t know where to start

Other

What is your dream goal?

I’d like to lose weight (fat) and fit into my old clothes again

I want to feel more energetic and healthy

I aim to build muscle and tone my body

Other

How long do you think it would take to accomplish this on your own?

Forever.

A long time without professional help.

I'm not sure.

Other

Do you want to sustain your goal after you achieve it?

Yes, maintaining my results is very important to me.

No its for short term only.

You already know it’s can be difficult to drop weight. Will you take our recommendations and do what we ask in order to help you reach your goal?

No.

Yes - I’m ready to commit to the program and follow the guidance.

Why are you applying now?

I want to lose weight, and I’m tired of struggling.

I’ve finally decided it’s time to take action.

I saw the success of others and want the same for myself.

Other

Do you think you’d reach your goal faster with an expert helping you along the way?

Yes

No