First Name *

Last Name *

Email *

Phone *

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What is the URL of your personal Facebook, LinkedIn Profile, OR Instagram Handle? *

What is your current frustration when it comes to your health journey? *

How would you describe your current fitness level? *

0 - This is my comeback
1 - Some weight training, but have been inconsistent
2 - I’ve worked with a trainer but not seeing results
3 - Consistent training 4 - 5 days per week but want to level up fully
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Have you ever played sports - high school, college, intramural/recreation? *

Yes

What sport and When?

How would you rate your current food routine? *

0 - I have no current routine, this is what I need
1 - I am inconsistent because I get bored
2 - I’m not sure my current routine still works for me
3 - It’s time to level this up
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Have you ever joined an online health and fitness program? *

Yes

What was the program?

Do you have full gym equipment or access to a gym? *

Yes

Are you open to going to a gym?

Yes

Are you able to commit to training 4 - 5 days per week with daily activity? *

Yes

Do you have any major/chronic health concerns that need to be addressed (answer honestly, this is for safety and awareness)? *

Yes

Do you agree to discuss these with Coach Netra if you are selected?

Do you have any injuries that prevent you from doing certain exercises? *

Yes

What is it/are they and any modifications you need

Do you have any issues with diverse backgrounds - culture, race, gender etc.? *

Yes

What is your primary reason for wanting to do this program? *

Are you prepared to make a financial investment in you? *

Yes
No
Maybe
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If you are selected, what is your realistic goal for the 12 weeks? *