The main office for Complete Body is based in New York City. However, we do have a team of personal trainers available around the world and abroad. Please take 3 minutes to fill out the following questionnaire. All client information is strictly confidential and never shared with anyone else. * - marked fields are mandatory
Name and Address
Name *
E-Mail Address *
Street Address
City
Country
State or Province	Postal Code
Home Phone Number (country code included, please)
Business Phone Number	Fax
Personal Information
Date of Birth	Age
Sex
Height	Weight
Weight 1 year ago	Weight at 21 years of age
Occupation:
Medical Information
Do you have any physical or medical condition that would limit you from engaging in a safe exercise program? Include any surgery you may have had . Yes No
If you answered yes in the question above, please explain in detail how your condition affects your athletic ability
List any medications you are currently taking:
Availability for Workout
How many times per week do you plan to train with us?
Please indicate the times and days you are available to train:
Please provide a day and time which would be convenient for you to schedule your initial Fitness Evaluation :
Alternative Day and Time:
What are your 3 main fitness goals?
Please indicate what you are looking for in a personal trainer?
Services Offered
Check any of the services/activites that interest you:
Outdoor Workout Sports Conditioning Physical Therapy Pre-Post Natal Therapy Nutritional Counseling Kick Boxing Horseback Riding Body-Building Trainers Available for Travel	Acupuncture Boxing Golf Dance Massage Yoga Fencing Water Sports Meal Delivery Other:
Where would you like to train? *
10 Hanover Sq 22 West 19th St 301 East 57th St Terrace Club 20 Pine St (residents only) 15 Broad St (residents only) 80 DeKalb (residents only) Sheffield (residents only) Visionaire (residents only) Verdesian (residents only) Solaire (residents only) Vanguard Chelsea Home Other :
Where did you hear about Complete Body? *