Schedule a Session

I look forward to helping you reach your health & fitness goals. To schedule a session, please fill out the brief questionnaire below. I will be in touch with you as soon as possible to schedule your session.

*required field

Name

First Name

Last Name

Age

Fitness History & Goals

How did you hear about Like Wine Fitness?

What type of session are you interested in?

Virtual One-on-One Training

Outdoor One-on-One Training

Balance & Stability Training

Custom

Other

What are your fitness goals? Please be specific.

Why now? What is your motivation?

What types of exercises do you enjoy?

What has worked for your fitness lifestyle in the past? What didn’t work?

General Information

What is your current occupation?

Do you partake in any recreational physical activities (golf, skiing, etc.)?

If yes, please explain.

Do you have any additional hobbies (reading, video games, etc.)?

If yes, please explain.

Medical Information

Any health concerns that need to be considered and may need medical clearance?

• Chest pain • Heart Disease • High Blood Pressure • Diabetes • Chronic Joint Pain or Arthritis • Dizziness

Are you currently taking any medication?

If yes, please explain.

Have you ever had any injuries or chronic pain?

If yes, please explain.

Have you ever had any surgeries?

If yes, please explain.