PERSONAL TRAINING & MORE
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Contact Appointment Form


XTREME ADVANTAGE PERSONAL TRAINING & MORE
19409 E. 10 Mile Rd.
Roseville, Mi. 48066
(586) 778-5222
Email: xtremeadvantage@gmail.com



PLEASE FILL OUT FORM BELOW OR CALL FOR AN APPOINTMENT
(586) 778-5222 ~ 19409 E. 10 Mile Rd. ~ Roseville, Mi. 48066

Name:  (REQUIRED)
Address:
City:
State:    Zip code:  
Phone:  (REQUIRED)
Email address:  (REQUIRED)
Your Age:
Your Height: ft. inches
Your Weight: lbs.
Your Sex: Male     Female
1. How did you hear
about (or find) us?
1A. If you were referred,
who referred you?
2.What is your service
of interest?
3. What are your areas
of concern?
(Please check one or more)
Weight (Fat) Loss
Muscle Toning (Sculpting)
Muscle Building
Strength & Conditioning
Athletic Performance
Endurance & Flexibility
Relieve Stress (Physical & Mental)
Overall Good Health
4. Are you also interested in a
Nutritional Guidance Program?
5. What is your level of fitness?
6. How many days per week
are you interested in training?
7. How long of a program
are you interested in?
8. When would you like
to start training?
9. When is the best time
to contact you?
ADDITIONAL INFO:
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 Why?
Letters are not case-sensitive
  

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