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General Information

Name
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Email
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Password
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Birthday
Height (inches)
Gender	Female Male
Goal Weight (pounds)
Goal Size

Personal Goals

What is your general weight goal?
How hard are you willing to exercise and plan your meals to achieve your desired results?

Current Exercise Regimen

Describe your exercise experience

Do you currently participate in cardio or aerobics training?	Yes No
Do you currently Strength Train?	Yes No
Will you workout at home or in a gym?
What is your current exercise program (include time and detail for each day of the week)?

Current Physical Shape

How would you best describe your level of exercise experience?
Please describe your current physical shape
How many hours per week will you REALISTICALLY devote to exercise?
How many days per week will you realistically exercise?
What special events are you training for, if any (races, competitions, weight loss competitions, wedding, reunions, etc.)?
What, if any, diet program do you follow? PNP is not a diet, it's a fitness community that works with various types of diets to achieve results.
Please estimate how many calories you consume in a typical day?

Medical Clearance

Phit-N-Phat Personal Training, LLC Waiver of Liability

Because physical exercise can be strenuous and subject to risk of serious injury, Phit-N-Phat Personal Training, LLC (“Phit-N-Phat”) urges you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You agree that by participating in physical exercise or training activities, you do so entirely at your own risk. Any recommendations for changes in diet are entirely your responsibility and you should consult a physician prior to undergoing any dietary changes. You agree that you are voluntarily participating in these activities and you assume all risks of injury, illness, or death.

You acknowledge that you have carefully read this “waiver of liability” and fully understand that it is a release of all liability. You expressly agree to release and discharge Phit-N-Phat and its officers, employees, agents, representatives, and all others from any and all claims or causes of action, including those based on any negligent act or omission of Phit-N-Phat or any individual affiliated with Phit-N-Phat, and you agree to voluntarily give up or waive any rights that you may otherwise have to bring legal action against Phit-N-Phat and its officers, employees, agents, representatives, and all others for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence.

If any portion of this release from liability shall be deemed by a court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect.

By clicking I ACCEPT you acknowledge that you understand its content and that this release cannot be modified orally.

This form will remain on file for the duration of your training with Phit-N-Phat. A copy can be given to you for your records upon request. This form can only be released to a third party with your expressed written consent.

I hereby affirm that I have read and fully understand the above by clicking I ACCEPT.

I ACCEPT

Miscellaneous

How did you hear about Phit-N-Phat?
What made you decide this is the program for you?
What is motivating you to make a lifestyle change for good?
How do you prefer to be motivated?
Now, tell us “your story” so we can really understand you and why PNP is right for you.

Your Starting Measurements

The following link will show you how to measure: http://phit-n-phat.com/content/OnlineCalculators.aspx
Weight
Body Fat (if known)
BMI (if known)

Phit-N-Phat Client Information

Phit-N-Phat Personal Training, LLC Waiver of Liability