- Axis Gym

Name

First

Last

What is your primary goal in the gym?

On a scale of 1-10, how important is that goal to you? (1 being not important at all, 10 being the most important)

What is your exercise experience?

Do you have any athletic background?

Yes
No

If yes, please list below:

Do you have any past injuries or ailments that could impact your exercise performance?

Yes
No

If yes, please list below:

on yes, being

How many days a week would you feel comfortable committing to exercise?

1-2
3-5
6-7

On a day-to-day basis, how would you rate your stress levels as a result of work, family, etc.? (1 being totally relaxed, 10 being on the verge of a mental breakdown)

Do you have any dietary restrictions or food allergies?

Yes
No

If yes, please list below:

What does a typical day of eating look like for you?

How many days a week do you consume alcohol?

0
1-2
3-5
6-7

Are there any new skills or modalities of exercise you would like to learn?

Yes
No

If yes, please list below:

What is your height?

What is your age?

What is your current body weight?

Please fill out the form below to the best of your ability. Once we have received your submission, we will go over everything, as well as any questions that you may have.