Name *


Email *


Phone *


How did you hear about Take It Outside! Fitness? *


What are you interested in? (classes, training, weight management, train via phone/email, receive updates/newsletters etc.) *


On a scale of 1-10 (1=no desire, 10=really want it!) how much do you want to reach your goals? *


On a scale of 1-10 (1=none, 10=I'm ready and committed!!) how much effort are willing to commit to your goals? *


Best times and days of the week to train (T&Th at 7am, any time after 6pm, etc) *


Prefered location to train (Mt Tabor Park, the studio, etc.) *


Tell me about your FITNESS GOALS or choose from below


reduce body fat

improve cardio capacity

improve muscle tone

exercise regularly/get into a routine

improve strength

injury rehab/management

have fun!

cross train

Tell me about your LIFESTYLE GOALS or choose from below


manage stress

have more energy

improve/maintain my quality of life

fit into my clothes better

feel better about myself

doctor's recommendations

improve/maintain my overall health

control blood pressure/cholesterol levels

sleep better

Tell me about your INTERESTS or choose from below


walking

nordic walking

joggin/running

stretching/yoga

pilates (mat)

pilates (reformer, equipment based)

classes

water aerobics/swimming

weight training

What BARRIERS seem to get in your way of sticking with your exercise program?


lack of time

don't see results

easily intimidated

injury/medical condition

not sure what to do

get bored

work responsibilities

family responsibilities

lack of motivation

Additional info