Transform Your Performance | Unlock Your Elite Fields marked with an * are required Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *PhoneAre you an Elite Athlete? *YesNoIf so, what sport (s) and position (s) do you play?If not, have you previously competed in sports, please elaborateOn average, how many times per week do you exercise? * *Zero 🙁1-2 Times Per Week3-4 Times Per Week5+ Times Per WeekWhat 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? *RightLeftDescribe 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 areasDo 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/stomach aches, dizzy spells, car/boat sickness, IBS/gut irritability, long-term use of antibiotics or NSAIDs, etc.? *Are you currently taking any medication or have any medical conditions? *Do any of the following describe your personality and/or normal day? Mark all that applyClumsyMovements aren't smoothMotion sicknessUncoordinated or less coordinated on one side of the bodyIncreased blood pressureCold hands or feetTremors at restSlow mental or physical responsesRigidCramping fingers and handsOften knocks things over when reaching for themDifficulty with mental focusAll injuries are on one side of the bodyDifficulty remembering where things areInability to maintain focusDepressed/loss of motivationDifficulty planningSlowness of movementVisually disturbedAnxietyTinnitusGut painDifficulty feeling "grounded"Difficulty smellingLoss of hearing clarityDyslexiaFatigueBlurred visionChanges in tasteSleep disturbancesDifficulty making decisionsIncreased levels of aggression and angerInability to remember key detailsDifficulty speakingElite Goals in Mind (lose weight, enhance sports performance (improve shot, speed..), gain weight etc) *Which services are you interested in?1-on-1 TrainingGroup TrainingMovement TrainingRehab/Pain ReliefConcussions/Special CasesNutrition CoachingOnline Training & Programming/AppConvenient time(s) to train (AM, Afternoon, PM)? *Desired day(s)?MondayTuesdayWednesdayThursdayFridaySaturdayHave you worked with a Trainer/Strength and Conditioning Coach before? *YesNoIf so, describe your experience (likes, dislikes)On a scale from 1-10, 10 being the highest, how serious are you about enhancing your performance? *12245678910Submit