Talk to a Center for Health & Fitness Trainer or Request an Appointment
First Name:
*
Last Name:
*
Phone Number:
*
Email:
*
General Information
Select your primary health & fitness goals:
Lose weight/body fat
Build muscle
Injury/surgery rehabilitation
Sports-specific training
Function/balance training
Pre/post-partum fitness
Disease management (arthritis, diabetes, etc.)
Stress reduction
Other
Tell us what you hope to gain with a trainer:
Knowledge of correct exercise
Techniques
Motivation
Goal-setting
Structured programming
Other
Do you prefer working with:
Male trainer
Female trainer
No preference
My available training times are:
5:30am - 9:00am
9:00am - Noon
Noon - 5:00pm
5:00pm - 8:00pm
Select if you have any of the following health considerations:
Arthritis
Diabetes
High blood-pressure
Heart disease/previous heart attack
High cholesterol
Osteoporosis/osteopenia
Previous stroke
Fibromyalgia
Joint replacement(s)
Back injury/degeneration or chronic pain
Other
(If other, please explain)
Referral Source
How did you learn about CHF Personal Training:
*
Former PT participant
Daily Breeze
Easy Reader
Beach Reporter
Former Member
Referral - Friend or Family
Referral - Employee
Referral - Physician
Postcard or Mailer
LiveWell Mailer
www.BeachCitiesGym.com
Facebook or Twitter
Community Event
Handout or Signage at CHF
Silver Sneakers or Silver Slippers
Other
(If other, please explain below)
Send me a copy of my responses
Submit
Privacy Notice
|
Report Abuse