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Ready? Let us
match you up with a Perfect Trainer! |
Name?
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E-mail address?
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| Phone Number?
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Cell
Home
Work |
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Alternate Phone Number?
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Cell
Home
Work |
How would you like to be
contacted?
Call
Me E-mail
Me Fax
Me Mail |
This request is
for:
Myself
Spouse My
Child
Age:
years old |
Address?
(Note that we need your City or Zip Code at the bare
minimum.) |
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While your Address is not important please
make sure you're in: area, pleas let us
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| When will you be ready?
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What were you looking to do?
(Go ahead- pick as many as you'd like)
Lose
Weight Tone Up
Add Muscle
Learn
Boxing/Karate Strict Self
Defense
Golf
Strength Conditioning
Running
& Endurance Training
Rehabilitation
Increase
Overall Health
Diet
Other:
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Would You also be interested in:
Massage
Nutritional
Evaluation
Physical
Therapy
Reiki
Sessions |
| Have you ever
taken:Yoga
Pilates
Boxing
Martial Arts
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| Would you be
interested in phone based training?
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Have you ever had a Personal
Trainer?
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Would you prefer
a Male or Female Trainer?
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Any other
requirements you'd like in a trainer (your selections are
confidential)?
White
Black
Latino
Gay
Senior Other:
Please feel free to express any concerns you might
have. |
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Did you have a specific trainer in mind?:
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Would you be interested in Buddy Packs (one of our
trainers could train 2, 3 or 4 people)?:
No
Yes
Maybe
- tell me more |
Where would you like to train?
Your own Home
Your own Office
Outdoors
One
of our Affiliate Gyms
(Please note that training in gyms usually requires additional fees) |
| How often do you think you'd like to meet
with your trainer?
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What times during the day would you like
to train?
(If you have multiple preferences, please
choose as many as you wish) |
What types of Training Package might you be interested in?
30
Minute Circuit Blasts
($85)
30
Minute Boxing Blasts ($85) Full
Hour
($125 to $155)
Full
Hour+ of Specialized Training (Pilates, Advanced Martial Arts, Golf, Etc.)
($155 to $250) |
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Do you belong to a
gym now?
If so, where?
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Do you exercise at
all now?
If so, how many times per week?
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| Are you recovering from any injuries?
Nature:
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Do you have any Pictures,
Special Diets or Doctors Orders you'd like for us to see?
(this
will upload your document to us) |
Please provide any
additional information you're comfortable sharing with us.
Your name, company name, phone & fax numbers, etc. Your
information will not be shared
and is considered confidential. We will not call you unless you
ask us to.
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How did you find hear or find out about us?
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When you're ready, please
press submit and we'll respond right away:
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Form Copyright ECA Westchester Personal Training, Bronxville,
N.Y., 2003. All Rights Reserved. For further information, please
e-mail us as info@westchesterpt.com
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