Intake form

Name *

Email address *

What are your primary fitness goals?

Please select at least one option.

Weight loss

Muscle toning

Increased energy

Improved flexibility

Stress relief

Overall health

How many children do you have?

What age range do your children fall into?

Please select at least one option.

0-2 years

3-5 years

6-12 years

13-18 years

What type of workouts do you prefer?

Please select at least one option.

Cardio

Strength training

Yoga

Pilates

Dance

Outdoor activities

How much time can you dedicate to workouts each week?

Are there any dietary restrictions or preferences in your family?

Please select at least one option.

Vegetarian

Vegan

Gluten-free

Dairy-free

Nut-free

No restrictions

What challenges do you face in achieving your fitness goals?

Additional questions or comments

Fit Mom Academy