Email Address *

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Yes, please!

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How did you hear about Drew Murphy Strength?

Have you worked with a Personal Trainer in the past?

Training Experience *

How long have you been working out?

Are you currently working out on a regular basis? *

If yes, what type of exercise? If no, how long has it been since you have regularly worked out?

How would you describe your eating habits? *

Are you willing to make adjustments to your eating habits?

If you wish, please elaborate on your eating habits.

Select all that you have experience with. Leave blank if none.

Resistance Training with Machines

Resistance Training with Free Weights

Powerlifting

Bodybuilding

Olympic Style Weightlifting

CrossFit

Playing a Sport

Running

Swimming

Cycling

Obstacle Course Racing

Which of the following exercises are you familiar with?

Please select all that apply.

Squat

Deadlift

Lunge

Plank

Rollouts

Overhead Press

Bench Press

Pull Up

Push Up

Muscle Up

Clean and Jerk

Snatch

Box Jumps

Jump Rope

Jogging

Sprinting

Please elaborate on any of the selections you made above.

Training Goals

(Select all that apply)

Increase Strength

Increase Muscle Mass

Lose Body Fat

Improve Flexibility

Improve Performance In A Specific Exercise

Improve Performance For A Sport

Improve Aerobic Conditioning

Prepare For An Event

General Health Improvement

On a scale of 1-10, how motivated are you to reach your goals? (1 = unmotivated, 10 = very motivated) *

On a scale of 1-10, how ready are you to be pushed during your workouts? (1 = not ready, 10 = very ready) *

Please elaborate on any of the selections you made above. If you have a primary training goal, please explain here.

What time/times of the day best fit your schedule to work out?

Please select all that apply.

Early AM

Mid AM

Late AM

Noon

Early Afternoon

Mid Afternoon

Late Afternoon

Evening

Very Flexible

How many days per week do you plan to work out? *

Health History

Please select all that apply.

High Blood Pressure

Diabetes

Liver Disease

Pregnant/Nursing

Shortness of Breath

Dizziness

Seizures

Heart Problems

Fractures

Joint Pain

Arthritis

Headaches

Smoker

Recent Surgery

Major Illness

Cancer

Asthma

Allergies

Neurological

Respiratory

Hernia

Scoliosis

Poor Balance/Coordination

Back Pain

Knee Pain

Shoulder Pain

Please explain all selections you made above.

Anything Else?

Please write all other information and concerns here.

Personal Training

Please fill out the form below to inquire about personal training.