4Star Fitness Information Form

First Name *

Email *

Where do you feel you need the most help in your journey? (Select all that apply) *

How would you classify yourself in your health and fitness journey? *

If other, please briefly explain

How would you classify your current lifestyle *

What seems to hold you back from reaching your health and fitness goals? (Select all that apply) *

Procrastination (i.e: not setting priorities)
Always busy- (i.e: Travel, Job, Family)
No Structure/Routine
Barriers or Limitations (ailments, pre-existing injury, hormones)
Habits that are not supportive (junk food, bad relationships/stressful situations)

If you have any barriers/limitations, please briefly explain

Do you have a history of obesity, high blood pressure, cardiovascular disease in your family? *

What is your age? *

What specific goals do you have that you would like to achieve? (Select all that apply) *

Any additional comments you would like to share?

Date / Time