FACE FORWARD FITNESS™
Copyright © 2009 Face Forward Fitness. All rights reserved.


 


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Copy entire form from start to finish into email provided below.
When you are finished completely filling out the form in your email, submit to email.

Request for a Complimentary Personal Consult
Instructions restated below for submitting

~~~~~~~Fill out entire form~~~~~~~

Start Here...

Full Name: (Be sure to type in First and Last names)

Best Phone #:    Alternative Phone #:

E-Mail:

If in the Los Angeles area, address:



 

Weight:

Height:

Pant Size:


What time of day should I contact you?
What Location do you prefer?
How did you hear about Face Forward Fitness?
 


(Current physical activity)

How often do you exercise per week?





 

 Do you have any exercise barriers?  Example: Lack of motivation, social support, prior injury or existing, lack of confidence, none, other

 (Dietary Patterns)

How many meals (including snacks) do you have per day?





 

On average, how long do you go between meals?





  

(Exercise time)  

Which time is most ideal for your training?  
5:30-8am  12pm - 4pm  5pm - 8pm   other

 

It is from my experience that working one day a week just does not cut it when trying to either lose weight, tone up, or build endurance. That is why my programs are built to either train 3, 4 or 5 times per week.

Two times a week would be for someone who is close or at their correct body fat and weight but needs to work on muscle strength and endurance.

Which three days of the week do you prefer to train?
Mon-Wed-Fri  Tue-Thurs-Sat  other days

Two times a week
Mon-Thurs Thurs-Sun   other days

 
(Goals)

Check all specific reasons that apply for entering the Face Forward Fitness program.

physician recommended   train for the specific event  sport  job   look and feel better need motivation  looking to motivate others
promote teamwork improve posture  increase energy  increase speed  increase strength  reduce cholesterol  increase cardiovascular endurance  weight loss  improve body composition  learn proper form technique, and modes to exercise  build or tone muscle  improve diet  injury rehab increase flexibility  reduce stress stop smoking reduce back pain prevent health risks  other

______________________________________________________________________________________________________________________________________________________________________________

Physical Activity Readiness Questionnaire
PAR-Q Assessment

       YES / NO

  1. Has your doctor ever said you have heart trouble?
  2. Do you frequently have pains in your heart and chest?
  3. Do you often feel faint or have spells of severe dizziness?
  4. Has a doctor ever said you have high blood pressure?
  5. Has a doctor ever said you have high cholesterol?
  6. Has your doctor ever told you that you have a bone or joint problem, such as arthritis?
  7. Have e you ever been diagnosed with having an eating disorder?
  8. Is there a good physical reason not mentioned here why you should not participate in activities?
  9. Are you over age 65 and not accustomed to vigorous exercise?
  10. Has your doctor given you permission to enlist in regular activity at the gym or with a trainer?

 Finished!

INSTRUCTIONS FOR SUBMITTING:
Copy from START point of form to FINISH point, cut and paste into an email provided by this Request Complimentary Personal Consult email Link. When you are finished completely filling out the form in your email, submit to email.

Thank you for completing the first section of your personal assessment. Within 24hrs a Face Forward team member will contact you to schedule the physical portion of your assessment. Your complete assessment will help me build a program that best suits your needs.

 I look forward to training with you.                                                                                                                                                    ACTIVE CLIENT WORKOUT WAIVER

Copyright © 2010 Face Forward Fitness All rights reserved.
Revised: 02/12/10