Thanks for an interest in our 1 to 1 and Small Group Program.

Congratulations! You just made the first step to a healthier new you!

Please take the time to fill out this questionnaire.

The most important qualification for this program is a true desire to change and a commitment to yourself, that you are important enough to take the time for yourself. Can you meet the qualifications of the program? *

What are you here for? Your goal(s)? *

What is your current fitness situation? *

What is your dream goal? *

How long would it take to accomplish this on your own? *

Do you want to sustain your goal after you achieve it? *

How long have you wanted this goal? *

Why do you want this so badly? *

You already know it’s not easy to get fit. Will you take our recommendations and do what we ask in order to help you reach your goal? *

Why are you applying today? *

Why do you think you’ll succeed this time? *

Our average Client loses 10 or more pounds with us in the first 2 months. Are you OK with this? *

What is your current weight? *

What is your desired weight? *

Have you struggled to lose weight in the past? *

Have you struggled with maintaining a self-directed fitness program in the past? *

Do you think you’d lose weight and or get fit faster with an expert helping you along the way? *

Do you think you would reach your goals faster with daily accountability? *

Is it more important to lose weight quickly or that it is permanent? *

Name *

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Email *

STRENGTH Rx,LLC

Thanks for an interest in our 1 to 1 and Small Group Program.

STRENGTH Rx,LLC

Need Help Getting Started? We’re Here to Help.

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