Training Inquiry

First name*

Last name*

Email*

Have you ever trained with us?*

Yes

What is your age?*

What is your height (inches)?*

What is your weight (lbs)?*

What is your body fat %?

Are you familiar with tracking your macronutrients?*

Yes

No, but willing to learn

Have you ever been diagnosed with an eating disorder?*

Yes

No, but I have struggled with my relationship with food and disordered behavior/thinking

We are looking for clients who are committed to the process and willing to invest in themselves. Are you willing to invest at least $450/month to achieve your goals?*

Yes

Often times the people we speak with have to talk to their partner or spouse before making a decision. Do you confirm that your partner/spouse knows we are speaking and is onboard and supportive of you making the decision for us to work together?*

Yes

N/A

Coaching with us requires you to check in with us in a timely fashion, be open minded and willing to try new things, and follow through with the commitments you make to your coach and to yourself.

If you end up working with MB Fitness and Dr. Jessie Virga, are you confident you will be able to follow through with these requirements? *

Yes

What kind of coaching are you looking for?*

Nutrition

Fitness

Both (Nutrition & Fitness)

Health Coaching for Business Leaders

What kind of coaching are you looking for?*

Lose Fat

Build Muscle

Metabolic Reset (Aka Reverse Diet)

Fix Gut Health