Boom Bodyshaping Studio

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Congratulations, you've taken the first step to achieving the body and lifestyle you deserve!

In order for us to understand your current lifestyle, fitness level and what kind of program you are looking for, please complete this brief Health & Fitness Questionnaire below. After you submit the form you can expect a call or email within 24 hours to schedule your complimentary Body Blueprint Consultation!

In order to better serve our members, BOOM Bodyshaping Studio is currently accepting limited clientel (90 total clients) for our results based programs and private studio. All sessions are by appointment only, and members are selected through our online Health & Fitness Questionnaire.

Name:
E-Mail:
Phone (cell):
Phone (home):
Gender:
Birth Date:
Height:
Weight:
Optimal Time to Exercise:
Occupation:
Favorite Workout Music:
Heart Disease
Pulmonary Disease
Metabolic Disease
Family History of Heart Disease
High Blood Pressure
High Cholesterol
Smoking
Sedentary Lifestyle
Chest Pain
Dizziness
Shortness of Breath
Irregular/Accelerated Heart Rate
Osteoporosis
Arthritis/ Joint Pain
Back Pain/Spine Disorder
Musculoskeletal Pain/ Injury
Hernia
Surgery
Other
Hypoglycemia
G.I. Disorder
High Triglycerides
Cancer
Pre/Postnatal
Anemia
Food Allergies
Are you over 69 and not used to being active?
Is your physician prescribing medication for a blood pressure or heart condition?
Has a physician ever told you that you have a bone or joint problem that will worsen with exercise?
How did you hear about us:
Do you know of any reason why you should not participate in physical activity?
How many days a week are you currently working out? (0-7x)
How long are your typical workouts? (ie. 30 minutes weights/ 30 minutes cardio, etc)
How many days a week would you realistically like to see yourself working out?
Describe Your Ideal Personal Trainer (personality, special interests, etc.)
What Are Your Fitness Goals (weight loss, definition, energy gain, etc.)
What are your interests (running, biking, swimming, etc)
Why should you be chosen as a candidate to work with us at the Studio?
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