PappsFitness Total Health & Wellness Application:

Name:

Email:

Please describe your previous health and wellness history (including past surgeries, any current physical limitations or mental illness, and family history):

Please describe your current fitness regiment (including how often, how long, and at what intensity you workout):

Please describe your current nutrition habits (including what types of food you eat, how much, and how often):

On a scale of 1-10 (10 being strongly agree), how much do you agree with the following statement: “I am dedicated to making a serious life change to enhance my total well-being.”:

Any medical issues that may limit you from participating in the PappsFitness Total Health and Wellness Program? If so, please describe:

What is your currently weight, in lbs?

Have you worked with an online coaching service before?

Please select all goals that apply: