First Name
*
Last Name
*
Email
*
Phone
*
How did you hear about TrYumph?
If applicable, who referred you? (we want to say thanks!)
What health “transformation” goals would you like to achieve? (check all that apply)
*
Lose 15 or more pounds
Improve my fitness level
Get off / stay off medications
Have more energy and stamina
Lower my blood pressure
Lower my A1C, cholesterol, and/or triglycerides
Regain my MOJO and self-confidence
Other
How can we help you be successful? (check all that apply)
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Give me a nutrition plan to follow that is realistic
I need guidance and accountability
Teach me the best types of exercises and proper form
Help me understand my blood labs and how I can improve my numbers
Improving my sleep
Managing my stress
Other
What has held you back in the past? (check all that apply)
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I’m confused about nutrition and what is really healthy.
I’m nervous about exercise because I don’t know what to do
Self sabotage!
Lack of support from family and friends
Lack of time and energy
I don't like to cook
Other
Survey question: Have you heard or read the most current research confirms that VO2 max and muscular strength are the top 2 predictors of functional healthspan (quality and quantity of life)?
YES
NO
I am not sure
Do you prefer onsite or online? (via zoom) consultation?
*
In person
Zoom
Either one
What time are you generally available for your consultation and health assessment? (Check all that apply)
*
M - F 8am - 12pm
M - F 12pm - 5pm
M - F 5pm - 8pm
Saturday 8am - 1p
Anything Else That You Think We Should Know?
Submit