I was referred bya: *
---Not ApplicableA DoctorA FriendAustin Fit MagazineCapital City VillageClass PassDirect MailDrove ByLiving SocialOutdoor SignageRadioReferral / Word of MouthTelevisionWang NewsletterWeb Search / OnlineYelpOther

Tell us about yourself

First Name *

Last Name *

Email Address *

State *
- Select Province/State -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon====================AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code *

Lifestyle/Daily Activity Routine:
(Describe a typical day from waking to sleep)
Activity History:
(Have you ever exercised before? If yes, what type and how often?)

Past/Current Medical Conditions:
ACL Rupture/ReconstructionCancer RecoveryCervical SpineDegenerative Joint DiseaseDisc HerniationDiabetesFibromyalgiaFunctional TrainingHypertension Exercisempingement SyndromeLower Back PainMeniscal TearPatello-femoral SyndromePost PartumPost Surgical: Knee/Back/ShoulderRotator Cuff TearSpinal StabilizationSpinal StenosisTotal Hip ReplacementTotal Knee ReplacementOther
Activity History:

Desired Changes/Goals:
Balance/CoordinationCardiac RehabilitationCardiovascular TrainingCycling ImprovementEnduranceFlexibility TrainingIronhorse Elite Athlete FitnessMedical Exercise for Disease ManagementPhysical TherapyPost Surgical Fitness CampsPost Surgical RehabilitationProfessional Fitness TrainingProfessional Resistance/Strength TrainingRunning ImprovementSenior ConditioningSports Injury PreventionSports Specific Performance EnhancementStaminaSwim TrainingWeight ReleaseOther
More detail on any checked box above:
Long Term Goals (6-12 months):
Short Term Goals (0-6 months):

Number of Days per week:1234567
Time to train - first preference:
Time to train - second preference:
Time to train - third preference:
Time to train - fourth preference: