First Quarter Accountability Challenge

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First Quarter Accountability Challenge
PERSONAL AND SMALL GROUP TRAINING
- NEW CLIENT SURVEY
NUTRITION COACHING
ABOUT ME
YOGA

HOME
First Quarter Accountability Challenge
PERSONAL AND SMALL GROUP TRAINING
- NEW CLIENT SURVEY
NUTRITION COACHING
ABOUT ME
YOGA

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First Quarter Accountability Challenge

* Indicates required field

Name *

First

Last

Email *

Phone Number *

What is your age? *

Current Weight? *

Height? *

Gender? *

Female Male

What are your goals? *

Lose weight (lose at least 10-15 lbs) Body Composition Change (lose 10-15 lbs or less while building muscle) Gain Muscle Mass (Build muscle and increase overall body weight) Improve Health (improve health and maintain current body weight)

Check all that apply.

Ladies only: Do you still have a period? *

Ladies only: Have you ever had your hormone levels checked? *

Dietary Preference? *

Anything Ketogenic Vegan Vegetarian Paleo

Goal Weight (if goal is to Lose Weight or Gain Muscle Mass) *

Hit me with your "WHY?" What do you hope to get out of this challenge? (other than the pot o' money) *

Tell me about a typical day for you. For example: Wake at 6 am, work from 7am-4pm, walk my dog about 1/2 mile, dinner by 6, Netflix by 7pm, bed by 9pm. *

How many days a week do you plan on working out during this challenge? *

How many times would you like to eat per day? (2-8) *

If you workout outside of our time together, describe a typical routine. *

Please add any questions or other notes you'd like to add here. Be open and honest, the more data I have to work with, the better I can prescribe your calorie/energy intake! *

Submit

SHAKTI FIT

shaktifityoga@gmail.com
419-957-1997
20495 Arrington Road Utica, Ohio

Nutrition. Training. Yoga.