Name *

First Name

Last Name

What time of day do you plan to workout? *

Early Morning (5a-8a)

Mid/Late Morning (9a-Noon)

Midday (Noon - 3p)

Afternoon/Evening (4p-7p)

Other

Can you commit to working out at least twice a week? *

Yes

No

Are you in good general condition? *

Yes

No

Unsure

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

Yes

No

You know these goals aren't easy. Will you take our recommendations and do what we ask in order to achieve them? *

Yes

No

Have you struggled to lose weight in the past? *

Yes

No

Have you struggled with maintaining a self-directed fitness program in the past? *

Yes

No

Is it more important that you accomplish your goal quickly or permanently? *

Quickly

Permanently