Skip to main content
Home
Pricing & Plans
Diet Plans
Women's Health
Pain Therapy
Heart Disease
Free 15 Consultation
Home
Pricing & Plans
Diet Plans
Women's Health
Pain Therapy
Heart Disease
Free Consultation
Today your life changes for the better!
Free 15 Minute Consultation
Name
*
Email Address
*
Phone Number
*
+1
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saba
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Eustatius
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Date of Birth
Goals
*
Prenatal/Post-Postpartum Consult
New Equipment Training
Lose Body Fat
Gain Muscle
Core Strength
Increase Flexibility & Balance
Improve Nutrition
Stress Management
Cooking Classes
Post Op Recovery
Injury Recovery
Clinical Labs Review
Physician Visit Support
Senior Health
Family Dementia Consult
Elder Care Resources
Diabetes Program
Hypertension Program
High Cholesterol Program
Autoimmune Disease Program
Dementia Exercise Program
Occupation
Body Height
Body Weight
Current Fitness Conditions & Goals
Preferred workout days and time:
Fitness Goal:
List any exercise you are currently doing:
List previous surgeries if any:
List any type of actual pain or discomfort:
List any medical conditions if any:
List any drugs or medications you are currently taking:
Fitness Habits
How many OZ of water do you drink per day?
Do you drink alcohol? What type? How often?
Do you crave carbohydrates & sugars?
Yes
No
Do you smoke?
Yes
No
Do you eat before and after training?
Yes
No
Are you taking any supplements? If so, please specify brand, supplements amounts and dosage.
How many hours per day do you usually sleep?
At what time do you usually go to sleep?
At what time do you wake up?
Do you feel tired when you wake up?
Yes
No
Are you tired during the day?
Yes
No
How would you rate your stress level?
Low
Medium
High
Sample of Diet
Breakfast – time and typical food you eat
Morning Snack – time and typical food you eat
Lunch – time and typical food you eat
Dinner – time and typical food you eat
Afternoon Snack – time and typical food you eat
Any final comments or special request for the consultation?
I agree with the
terms of service
Submit
First Name