LMF Intake

INTAKE FORM

Thank you for the interest in Lift.Move.Fuel services!
Please fill out the form below and "SUBMIT" it when complete.
Please complete the form below as it is sent directly to us for review, providing her a better understanding of your goals and history.
Once the completed information is received, one of our coaches will be in touch with you to discuss your goals and a plan. This entire process is FREE of charge.

Complete the information Below

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Age *

Height *

Gender *

Current Body Weight (lbs) *

Heaviest Body Weight in the past year *

What are your health and fitness goals? *

How often and at what intensity do you train each week? *

What do you feel your current fitness and health plan is lacking? *

List any medical conditions *

Motivation - on a scale of 1-10 (10 being highest) how ready are you for a lifestyle change? *

Are there any issues with your support system or circle? *

How did you hear about us? *

What style of training are you interested in? (Select One ) *

Online Small Group 1:1 Personal Training Nutrition Only

For Personal Training: Why are you considering hiring a personal trainer? *

For Personal Training: What day/times would work best for your sessions? *

Is there anything else we should know? *

Assessment and coaching services provided by Lift Move Fuel are intended for educational and informational purposes only and not intended to be medical advice. Speak to your doctor before starting this program or making any changes to your diet *

I acknowledge, understand and agree to the above

Submit