Skip to content
Mrsbritfit
BB Fit Signup
BB Fit Login
About
Coaching Programs
8 Week Challenge
Client Testimonials
Resources
Contact
X
About
Coaching Programs
8 Week Challenge
Client Testimonials
Resources
Contact
X
BB Fit Signup
BB Fit Login
Questionnaire
Please enable JavaScript in your browser to complete this form.
Client's Information
Today's Date
*
Name
*
Phone
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Age
*
Email
*
Client's Measurements
Height
*
Ft/In
Current Weight
*
lbs
What is your primary fitness goal for this challenge?
*
Lose weight/body fat
Reshape or tone your body
Increase muscle mass
Other:
If "other", please explain:
What are you hoping to gain from this program?
*
Do you smoke?
*
Often
Occassionally
Rarely
Never
Do you drink alcohol?
*
Often
Occassionally
Rarely
Never
Do you have any current or previous medical conditions or injuries? Medications?
*
Workouts
On a scale of 1-5 (1 being poor, 5 being excellent) How have you been feeling mentally with your current exercise & nutrition routine?
*
1
2
3
4
5
On a scale of 1-5 (1 being too easy, 5 being extremely challenging) How challenging do you find your workouts?
*
1
2
3
4
5
Will you be working out at home or the gym?
*
Home
Gym
What is your current workout routine?
*
Additional comment/questions/feedback?
*
Send A Request