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Home
About
in-person
Online
Contact
Strength Coaching
Form
Contact Emerge Stronger
Please complete the form below
Name
*
First Name
Last Name
Email
*
Phone Number
*
Service(s) you are interested in:
*
In-Person Training
Online Strength Coaching
Gender
*
Height (Include Units)
*
Body Weight (Include Units)
*
Waist Circumference (Include Units)
In general, what are your goals?
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Get stronger
Learn more efficient and effective lifting technique
Improve overall health
Improve physical fitness
Improve athletic performance
Look better
Feel better
Have more energy and vitality
Healthy aging
Get off or decrease medication
Lose weight / fat
Gain weight / muscle
How, specifically, would you like your habits, your health, and / or your body to be different?
Until now, what has blocked you or held you back from changing these things?
If you are already training, what are your current squat, bench, press and deadlift numbers? Please include weights, units, repetitions, and sets.
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What days of the week do you typically train and what exercises do you do each day?
Where do you train (gym, garage) and what equipment do you have access to?
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Do you participate in any sports or other types of physical activity for fitness and enjoyment? (e.g., hiking, gardening, yoga, group fitness, long dog walks, jiujitsu) If so, what do you do and how often do you do it?
*
Do you have any previous injuries that I should be aware of? Are there any movements you cannot perform?
Who lives with you?
Spouse or partner(s)
Roommate(s)
Child(ren)
Pet(s)
Other family (e.g., parent, grandparent, sibling, etc.)
How will you reward yourself as you start achieving your goals? (Will you take a trip or try a new sport / hobby?)
Please include any other pertinent information that you think I should know. For example, if you are taking any regular medications, please list them here.
Thank you!
