Assessment Sign-up

Name

Email Address

Phone Number

What are your Short Term (3 Month) Fitness Goals?

What are your Long Term (6 Month+) Fitness Goals?

What Equipment do you have at Home?

What is your current exercise program?

How are your eating habits? How are your eating habits? *Room to ImprovePretty GoodNot a Concern

What does a typical day look like for you?

What types of sessions are you interested in ( check all that apply)? What types of sessions are you interested in ( check all that apply)? One-on-One Buddy Session Small Group Fitness Family Session

How would your prefer your session? How would your prefer your session? *VirtualAt the StudioIn-home

What times work best for you? What times work best for you? Morning Afternoon Evening

Which days work best for you? Which days work best for you? Monday Tuesday Wednesday Thursday Friday Saturday

How did you hear about Devine Impact?

Anything else you'd like to let Devine Impact know about your health?