Name First Last PhoneEmail Are you happy with your current health condition? Yes No What areas are you looking to improve?What success, if any, have you had in the past with exercise and nutrition??Have you ever taken a group class? Yes No On a scale of 1 to 10, how ready are you to make changes to your exercise and fitness regimen? 1 2 3 4 5 6 7 8 9 10 Help Prevent Spam: What is 2+3?*Please enter a number from 5 to 5.