PRIME ID Individually Designed Program + Remote Coaching Name * First Name Last Name Email * Phone * (###) ### #### Instagram Handle * Age * Briefly tell us about yourself! 😁 Occupation, Interests, Hobbies, etc. What are your goals? (Check all that apply) Lose Body Fat Gain Muscle Improve Body Composition at Current Weight Have more energy and vitality Get rid of specific pains or limitations Improve Athletic Performance What is holding you back from reaching your goals? * This can be anything: aches/pains, schedule, motivation, lack of a plan, etc. Please provide at least 2 items and be detailed. Thanks! Where are you getting your current exercise routine from? * Please select 1 answer I am currently working with an in-person coach/trainer. I am currently working with an online coach/trainer . I follow a program that I created myself. I go to a group fitness class. It's kind of random right now. I am not doing any exercise right now. What does your current exercise routine look like? * Please select 1 answer Strength training / weight lifting only A mix of strength training and cardio everyday A few strength training days and a few cardio days Only cardio/HIIT Mainly stretching/yoga Why have you chosen to work with Prime Movement and Performance? * How did you hear about us? * Anthony Mucurio (@amucurio) Prime's Main IG (@primemvmnt) A fam/friend who is currently or has worked with Prime referred me.. Google/Internet Browsing Other Are you willing to spend a few hundred dollars per month to make this physical, mental and financial investment? * Yes, I am ready! No, I am not ready Anything else you'd to mention? Thanks for taking the time to fill this out! You can expect a text or email from one of our coaches within 24 hours!
