Free Consult

Interested in improving your personal fitness? Complete the Free Consult request form below and submit it today. After submitting your information, please call the gym at 410-825-3600. Be sure to leave a message. Someone will contact you today to schedule your appointment.

*  =  Required information

Personal Information

*First Name:
*Last Name:
Address1:
Address2:
City/Town/County:
State:
Zip Code:
Home Phone:
Work Phone:
*Cell Phone:
*E-mail:

Client History

Birth Date:
Height:
Present Weight:
Years at Present Weight:
Highest Weight:
Desired Weight:
How many days per week are you currently doing aerobic exercise-i.e., walking, treadmill, bike, etc.?  0 1 2 3 4 5 6 7

Desired Goals

What time of day would you like to train?	morning noon afternoon evening
Where do you rate health & fitness in your life?
(high priority) 1 2 3 4 5 (low priority)
What would you Specifically like to change or improve with your physique or figure?
Would you be interested in nutritional information?	Yes No

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