Hello and thank you for taking the first step to becoming Fit Again!

Below is a series of questions that will help me to give you the best service that I can!

Tony Mendoza Jr.- CPT

New Client Questionnaire

Please answer the following questions the best you can.
I will respond to your inquiry within 24 hours.

* indicates required field

First Name: *

Last Name: *

Email: *

Address:

City:

State:

Zip Code:

Phone:

Height:

Weight:

Ideal Weight:

Occupation:

Any chronic illness, injury, or range of motion limitations?:

Any past physical injuries (where & what year)?:

Are you taking any medications? If yes please list:

Current Exercise Routine (If Any):

Current Flexibility work? (If Any):

Exercise History (ever peformed resistance exercise,details)?:

Fitness Goals (what would you like to achieve)?:

Home Gym Equipment (describe what you have,if any):

How many times per day do you eat?:

How many times per week do you eat fast food?:

Do you consume caffeine? If yes, how many servings a day?:

Are you ever hungry again within 1-2 hours of eating?:

Do you sleep at least 7-8 hours per day?:

Dietary Habits (please give me a detailed list of your typical daily intake of food and/or any nutritional supplements being taken):

Any Additional Comments/Questions:

CAPTCHA Code: *