Fitness Challenge Interest Form

Accountability Group

* Required

Last Name *
This is a required question
Email Address *
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First Name *
This is a required question
Preferred Method of Contact *
• Email
• Facebook
• Phone
• Other
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What are your fitness goals? *
Check all that apply
• Lose Weight
• Tone Up
• Gain Weigh
• Increase Energy
• Build Muscle Mass
• Sleep Better
• Other
This is a required question
Have you participated in one of my Facebook Challenges before? If so which one and when?
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What are the reasons you want to get in shape and/or lose weight? Please be very detailed in explaining why you want this change. *
(For example: self confidence- health issues- example to kids)
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Do you currently workout? *
• Yes
• No
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If yes what do you currently do: how often and how long?
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What types of exercises are you naturally drawn to? *
• Dance
• Atheltic
• Resistance
• Yoga/Pilates
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How many minutes a day can you and are you willing to commit to exercise? *
• Less than 25 minutes
• 25-30 minutes
• 30-45 minutes
• 45-60 ,minutes
• 60 minutes or more
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Do you have any physical limitations/injuries I should be aware of? *
• Yes
• No
This is a required question
What are your current eating habits? *
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Do you have any food preferences? *
Vegetarian, Vegan, Gluten Free, etc.)
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How would you describe your "bad" eating habits?
Picky, love sweets, grab fast food often, love fried foods, etc
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What are your biggest struggles when it comes to living healthier? *
Select all that apply
• Eating Properly
• Staying Motivated to Exercise
• Knowing how to EFFECTIVELY exercise
• Feeling discouraged with results or lack of results
• Other
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Do you currently own any in-home workout programs? If so which ones? *
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Please make sure we are friends on Facebook. This is critical as I will need to be able to contact you to discuss your goals further
www.facebook.com/TrinaSchnur
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How much weight do you want to lose over the next 3 months? What are your current health/fitness goals? *
Is it just to lose # amount of weight or to run a 5K, lift X amount, etc.
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Thank you for being open and honest in your answers. You will get an honest recommendation from me based on your responses. If there is anything else you would like to share with me please do so below. You can't tell me too much. Your success is based upon us starting out right.
Have a great day!
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Facebook Address *
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