Chad Contact - Cognitive Fitness and Nutrition

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NAME *

First

Last

AGE *

CURRENT BODY WEIGHT *

# OF YEARS EXERCISING, LIFTING WEIGHTS, AND SPORTS HISTORY *

# OF DAYS YOU CAN REALISTICALLY WORKOUT & LENGTH OF TIME DURING THOSE SESSIONS AVAILABLE *

ANY CURRENT SERIOUS INJURIES, SURGERIES, AND/ OR TRAUMA *

CURRENT TRAINING *

GYM EQUIPMENT AVAILABLE *

COMPETITION PR’S ALONG WITH DATE MADE *

GYM PR’S ALONG WITH DATE MADE *

LONG TERM GOALS *

ANY OTHER IMPORTANT INFORMATION I SHOULD KNOW *

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Last

Email *

Are you interested in: *

Age *

Body weight

Height

Do you work out? Please specify.

Please describe your fitness goal?

What is your biggest struggle when it comes to achieving your fitness goals?

Comments or questions that you would like to add?

We operate on an abundant mindset. We are sure we can give you the tools and support to succeed. Are you ready to achieve your goal and invest in yourself with a budget between $200 - $400+ a month?

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