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PRE-Consultation Form
*
Indicates required field
Name
*
First
Last
Email
*
Skype Username (if available)
*
Phone Number
*
Age
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
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Ohio
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Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
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Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
How many times a week you train on average?
*
Once per week
2 to 3 times per week
4 to 5 times per week
6 to 7 times per week
How many years have you been lifting?
*
Less than 1 year
1 - 2 years
3 - 5 years
6 - 10 years
More than 10 years
How did you hear about me?
*
Instagram
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YouTube
Other
If Other, please specify.
*
Were you referred by a current client?
*
Yes
No
If yes, who?
*
***LIABILITY RELEASE STATEMENT***
I ACKNOWLEDGE THAT I AM CURRENTLY HEALTHY ENOUGH TO
PARTICIPATE IN PHYSICAL ACTIVITY AND UNDERSTAND THAT
COLLIN WHITNEY, OR WHITNEY STRENGTH &
PERFORMANCE LLC, WILL NOT BE LIABLE FOR ANY INJURY THAT
MAY OCCUR DURING A TRAINING PROGRAM, PERSONAL
TRAINING SESSION, UPCOMING MEET(S)/EVENT(S) DURING OR
AFTER COMPLETION OF A SESSION, PROGRAM, OR SKYPE CONSULTATION.
Please indicate that you understand and agree to the Liability Statement by e-signing below.
*
I agree to comply with the Liability Release Statement above.
Signature
*
Date
*
Submit
Home
About
PWRBLD Online
PWRBLD Account
Training
Level Up Program
Online Training Options
Personal Training
1:1 Consultation
Shop
PWRBLD Merch
Testimonials
Contact Me
Personal Training