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Birthday
Month
Day
Year
Are you currently cleared by a doctor for exercise?
Yes
No
What are your primary fitness goals? (Select all that apply)
How would you describe your current stress level?

Emotional & Mental Health

Would you like a mental health/ emotional approach?
Yes
No

This is optional. If yes, continue with the next 3 questions. If no, skip the next three questions.

Do you currently use exercise to help with:

Fitness & Health Background

Current Fitness Level
Sedentary (little to no exercise)
Lightly active (1-2 days / week)
Moderately active (3-4 days / week)
Very Active (5+ days / week)
Any current or past injuries, surgeries, or medical conditions that may affect exercise?
No
Yes

If Yes, please explain


Target areas of concentration

In this box list where and what areas of the body you'd like to tone or strengthen. (This is for exercise choice)

Equipment & Environment

Leave blank if you will schedule your own.

Where will you be doing your workouts?
Equipment Available

If other, please explain

Time & Schedule

How many days per week can you commit to working out?
1
2
3
4
5+
Preferred workout length:
Preferred workout time:

Workout Style & Music

Which workout styles interest you?
Favorite music genres to listen to ( check all that apply):

Optional One-on-One Support

Would you like one-on-one personal training or coaching sessions in the future? (In-person or virtual)
No, written plan only
Yes, I’d like to learn more about one-on-one in the near future
Would you like your coaching to be trauma informed where we find ways to regulate the nervous system and mental well-being using the the fitness approach?
No, Workout plan only
Yes, I’d like health + emotional wellness coaching included
Maybe, I’d like more information before deciding

Agreement

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Month
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Cor.E.motions, LLC
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