Fields marked with an * are required

    First Name*

    Last Name*


    What is your No.1 health or fitness goal?

    Explain your current situation. How are you feeling? What are your concerns? What are your main complaints?

    Have you tried any "diets" in the past? Please describe. *

    Have you ever worked with a trainer before? Online of offline? What was the experience like? *

    As it pertains to your wellness goals, what would you love to see happen in your life over the next 6 months? *

    In your opinion, what is the biggest obstacle in your life that is holding you back from achieving this? *

    Is there anything else you'd like us to know before we chat?