AKTIV|HEALTH
Programs Form Contact
AKTIV|HEALTH
ProgramsFormContact

Client Info Surveys

This survey is intended for individuals that have purchased a personalized diet plan or are participating in a 60 day challenge from the ‘programs’ page.

*diet plan will be ready 4-5 business days after SURVEY COMPLETION*

Client Information
Name *
In your opinion, briefly explain the ONE main thing stopping you from achieving your goal written above? You can say things like 'I need accountability' or 'I don't know how to train effectively,' 'I don't know what to eat or proper quantities for me'...etc
Likes, dislikes, favorite cheat meals..etc
Please provide any information about work, family, fitness, or health you deem valuable for me to know. (again, BE SPECIFIC)
I agree to the terms and conditions *

Thank you! We will get back to you within 48 hours during normal business days (M-F)

Terms and Conditions

* ‘Workout Form’ is for existing clientele that have gone through Nutrition Programming previously*

Workout Form
Name *
Does it involve extended periods of sitting or repetitive movements? (If yes, please explain)
ankle, knee, hip, back, shoulder, etc.? (If yes, please explain)
asthma, coronary heart disease, coronary artery disease, hypertension, (high blood pressure), high cholesterol, diabetes, or other? (If yes, please explain.)
(If yes, please explain)
Stronger? Faster? Mobility? Overall Health? Specific Body Parts?
Terms and Conditions *
Thank you!
2624421971 aktivhealth@gmail.com
Hours
Terms & Conditions