1 on 1 Training

First Name (required)

Last Name (required)

Age (required)

Gender (required)

Current Weight (required)

Height (required)

email (required)

Please list overall goals (body weight, max weights, etc,) (required)

Does your gym offer any speciality equipment? (bars, bands, chains, etc.) (required)

Please identify estimated 1RM (rep max) and 5RM for the following lifts: (required)
Bench Press:

Squat:

Deadlift:

Shoulder Press:

Please identify other lifts 1RM and 5RM (if known) in the space provided:(required)

Please identify any prior injuries, and or limitations on any exercises that could limit your abilities:

In the space provided, please identify your honest and best estimated current diet:

Please identify your current and honest eating habits in the space provided:

In the space provided, please list all food allergies, dislikes, and foods you try to avoid: