Schedule a Consultation

You’re one short form away from beginning your journey back to health!

Tell me a little bit about yourself

By providing a little bit of information about your day-to-day activities, your background, preferences and what you hope to achieve, I will be able to better serve you when we have our first conversation. Please fill out the form below to get started.

Full Name

Phone Number

Email Address

I am interested in (or have had a doctor recommend) one or all of the following activities: I am interested in (or have had a doctor recommend) one or all of the following activities: General fitness (strength training, cardiovascular exercise) Yoga, Range of Motion and Flexibility Injury and Fall Prevention Exercise and/or Meditation For Stress Management Exercise for increased bone density (including recent diagnosis of Osteopenia or Osteoporosis) Weight loss or generalized fitness-related nutrition guidance Yoga-based health coaching

Age Age 18-34 35-50 50-65 65+

Gender Identification Gender Identification Male Female I'd rather not say

Please list your personal interests and favorite physical activities

To the degree that you are comfortable, please tell me about injuries or illness you have been, or are currently experiencing (this is helpful, but not required now)

What do you do for work? If retired, simply write retired

On a scale of 1 - 5, how committed are you to beginning a fitness program?

Health & exercise background will be discussed when we talk. Do you have any other questions?

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