Contact – 3 in 1 Elite

Name *

First

Last

Email *

Phone

Are you an Elite Athlete? *

If so, what sport (s) and position (s) do you play?

If not, have you previously competed in sports, please elaborate

On average, how many times per week do you exercise? * *

What type of exercises/routine do you perform now? Ex. cardio 2x per week, strength training {targeted muscle groups, total body}, etc. * *

Tell us about a time when you were most "fit" in your lifetime. Include activities you were performing. *

Are you right or left handed? *

Describe any injuries/discomfort you may have *

Have you undergone any surgeries or traumatic events? Please be as descriptive as possible, this may include car accidents, concussions, broken bones, falls, dental work, etc. *

Please describe any scars or tattoos you may have and what areas

Do you wear glasses or contacts? When and for how long? Knowlingly, near or far-sighted? *

Do you have weak balance? Or do you experience vertigo, migraines, frequent headaches, dizzy spells, car sickness, IBS/gut irritability, etc.? *

Are you currently taking any medication or have any medical conditions? *

Mark all that apply

Elite Goals in Mind (lose weight, enhance sports performance (improve shot, speed..), gain weight etc) *

Which services would you like to sign up for?

Convenient time(s) to train (AM, Afternoon, PM)? *

Desired day(s)?

Have you worked with a Trainer/Strength and Conditioning Coach before? *

If so, describe your experience (likes, dislikes)

On a scale from 1-10, 10 being the highest, how serious are you about enhancing your performance? *

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