Consultation/Contact Us

Name:
E-mail:
Year of Birth:
Telephone:
General Questions:
To help me better understand your needs, please take a few minutes to answer the following questions:

Do you have any injury or condition, past or present that may affect your ability to do an exercise program?
If yes, please explain:
What is your current level of satisfaction with your exercise routine?
Have you ever worked with a personal professional trainer?
If yes, please describe your experience:
How difficult do you find it to achieve your fitness objectives?
What gets in the way? Please check all that apply. Lack of Knowledge
No follow-through
Lack of Commitment
Keep making excuses
I think I'm doing everything right, but it's not working
Intimidated by the gym atmosphere
I made progress at first, but now I am stuck
Other, please explain
What dissatisfaction do you have with the gym where you belong now?
Are you concerned about the risk of osteoporosis and other diseases related to inactivity and age?
If yes, what are you currently doing?
Indicated the type and amount of activities you do regularly (check all that apply): Walking Slow (20 minutes a mile)
Walking Fast (15 minutes a mile)
Jogging (10 minutes a mile)
Running (8 minutes a mile)
Leisure Cycling (6 mph)
Cycling Fast (12 mph)
Leisure Swimming
Racquet Sports
Calisthenics
Aerobics
Basketball and/or Football
Soccer or Similar Sport
Weight Training
Golf or Bowling
Downhill Skiing
Cross-Country Skiing
Water Skiing
Other
None
Average number of exercise sessions per week
Average duration of each session
On a scale of 1 to 5, on the average how hard do you work out (1=very light, 5=very hard)?
What are your fitness goals?
Additional information you feel is important for me to know when assessing your fitness goals:

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Thank You!

Gusler Body Sculpting Fitness Center, LLC
459 Acoma Street · Denver, Colorado 80204 · 303-860-7131
Hours: Monday-Friday: 7-12, 4-9 · Saturday: 7-12 · Sunday: Closed