CONTACT INFORMATION:

First Name *

Last Name *

Phone *

Email *

PHYSICAL THERAPY AND/OR FITNESS OBJECTIVES:

What are you aiming to achieve in your fitness and health journey (like weight loss, muscle building, improved strength or endurance, control pain, flexibility)? Please list any specific goals. *

CURRENT ROUTINE:

Do you have a workout routine? What’s the frequency and intensity like? What else have you tried? *

ACCESSIBILITY:

What equipment do you have at home or access to a full gym? *

PAST EXPERIENCES:

Have you worked with a physical therapist or health coach before? What was that experience like? *

SCHEDULE AND TIME COMMITMENT:

To meet goals you have to put in energy and time for change. When are you generally available for training or in person visits? (Dependent on location and goals.) *

DIETARY HABITS:

Do you follow any particular nutritional plan, diet or food restrictions we should know about? *

MOTIVATION LEVEL:

On a scale of 1-10, how motivated are you to reach your goals? *

FINANCIAL COMMITMENT:

Working with T-REX Physical Therapy is an investment in your health, involving both time and money. Can you afford the physical therapy, training and/or coaching for the duration of your selected program? If we got you towards your goals, would you feel comfortable to invest? *

By participating, you consent to receive text, email, and phone calls, including marketing communications, from T-REX Physical Therapy and Wellness. These messages may be sent by an automatic telephone dialing system. Consent to these terms is not a condition of purchase. Message and data rates may apply. You can opt-out or unsubscribe at any time. For more information, please refer to our Terms of Use and Privacy Policy.