Home > Contact Us
  

Contact us today for more information and strive to become One Day Better!

Call us at (703) 901-8087
Email us at info@bouncenow.net
                          P.O. Box 305 Fairfax Station, VA 22039
 

To schedule your Free Training Session, Group Yoga Class, or Long Distance Telephone Consultation, please fill out and send the Personal Profile form below ...

Personal Profile Form

You are about to change your life forever. The information you provide in your Personal Profile form will be kept in strictest confidence. Please be specific.

First Name  
Last Name  
Date of Birth
 
Address
City
 
State Zip Code  
 
Home Phone  
Cellular Phone  
Work Phone  
Email
Web Site Address
How did you learn about Us?
Has a physician ever advised you against exercise?
 NO    YES, please explain:
Gender:
 Male
Female
Pregnant Female    months.
Please explain any health problems you have, medications you take, including dosages and therapies you are under going here.
Do you have any injuries?

 NO   YES, please explain:
How do you rate your over-all health?
Consumption of:  
Alcohol times/week Nicotine/Tobacco times/week
Caffeine times/week Other times/week
Do you have a nutritionist?
 NO   YES
Do you have any children?
 NO   YES,
How would you describe yourself to someone who has never meet you?
Explain a typical day in your life.
What specialty groups are you currently working with, if any?
Can you pinpoint what stresses you?
How do you relax?
Whom do you admire?
What qualities do these persons possess?
What motivates you?
What are you passionate about?
What are your strengths?
What are your weaknesses?
What are your greatest accomplishments?
What type of music do you like?
What type of home exercise equipment do you own?
What health clubs are you currently a member of?
Have you ever worked with a personal trainer before?
 NO     YES, Name of facility:
In what state?
For how long?
Why would you hire a personal trainer?
Are you training for a specific event, occasion or sport?
 NO    YES, Describe:

Describe your current exercise program:

Days a week of weight training and body sculpting
Days a week of cardiovascular activity
Type of cardiovascular activity
Minutes stretching each week
What do you want to accomplish immediately with your trainer?
What are your long-range personal fitness and health goals?
What do you expect to accomplish?
What are the most convenient days and times for you to meet with your trainer? (You may select several with CONTROL-CLICK)
What days and times are completely not possible for you?
I want to meet with my trainer:
I want to learn more about (check those items that apply):
Personal Training
Corporate Services
Sports Training
Yoga Training
Nutritional Programs
Youth Fitness
Boot Camp
Stretching / Flexibility
Group Training
Workout Programs


Additional information I want my trainer to know: