Personal Info
Full Name
Date of birth
Email
*
Phone
*
Deal Name / Internal Nickname
Preferred Method of Contact:
Phone call
Text message
Email
How Can We Help?
What are you primarily looking for?
Improve strength & fitness
Overcome pain / rehab an injury
Improve athletic performance
General health & wellness
Not sure / need guidance
What body areas or movements are currently limiting you?
Do you currently have pain or an injury?
No
Yes
Training & Activity Background
Are you currently training or exercising regularly?
Yes
No
What types of training have you done recently? (Select all that apply)
Strength training
Conditioning / cardio
Sports practices
Group classes
Physical therapy
None
Other
What sports or physical activities do you participate in?
Results & Motivation
What are your top 3 goals for the next 3–12 months?
What’s the biggest thing holding you back right now?
On a scale of 1–10, how committed are you to achieving these goals?
1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.
Logistics
How soon are you looking to start working with us?
ASAP
Within 1–2 weeks
This month
Just gathering information
Which location is most convenient for you?
Proton Rd Dallas
Other
No elements found. Consider changing the search query.
List is empty.
Preferred session times: (select all that apply)
Early morning (5am–9am)
Midday (9am–2pm)
Afternoon / Evening (2pm–8pm)
Weekends
Safety & History
Have you been diagnosed with any medical conditions we should be aware of?
No
Yes
Have you been cleared for physical activity by a medical provider?
No
Yes
Not Sure
Final Step
Is there anything else you’d like us to know?