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Home
About
Team
Packages
Schedule
Gallery
News
Contact
Start Assessment
Please fill out the form below.
To train with "Mike" please read the paragraph below...
At "We Train With Mike Ford", we take your health and training very serious. We would like to begin our initial assessment by getting a few pieces of information listed below...
Which training package are you interested in?
Please select ONLY one package, in any event you accidentally select more than one, please click the "Start Assessment" link to reset form.
Pro Training Packages
Platinum Training Package ($1700)
Gold Training Package ($1340)
Silver Training Package ($980)
Bronze Training Package ($620)
30 Minute Training Package
1 Session | 30 Minutes | 40.00 | 160/Month | 4 Month Minimum
2 Session | 30 Minutes | 35.00 | 280/Month | 4 Month Minimum
3 Session | 30 Minutes | 30.00 | 360/Month | 4 Month Minimum
One-Hour Training Package
1 Session | 60 Minutes | 70.00 | 280/Month | 4 Month Minimum
2 Session | 60 Minutes | 60.00 | 480/Month | 4 Month Minimum
3 Session | 60 Minutes | 50.00 | 600/Month | 4 Month Minimum
Group Rate Training Packages
2 People | 60 Minutes | 47.00 | 12 Sessions
3 People | 60 Minutes | 37.00 | 12 Sessions
4 People | 60 Minutes | 30.00 | 12 Sessions
Tell me more about you.
Date
*
Name
*
Address
*
Street Address
Apt, Suite, Bldg. (optional)
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d\'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Home/ Work Phone
*
Email
Age
*
Height
*
Current Weight
*
Ideal Weight
*
Current Body Fat %
Ideal Body Fat %
Emergency Contact Name
*
Emergency Contact Phone
*
Health Awareness
Regular exercise is associated with many health benefits. Increasing physical activity is safe for most people. However, some individuals should check with a physician before they become more physically active. Completion of this questionnaire is a first step when planning to increase the amount of physical activity in your life. Please read each question carefully and answer every question honestly:
1) Have you been a member of Mike Ford Personal Training before?
*
Yes
No
2) Have you been exercising regularly for the past 6 months?
*
Yes
No
3) During your last program did your progress slow dramatically after the first few weeks?
*
Yes
No
4) Have you ever used a Personal Trainer?
*
Yes
No
5) Do you smoke?
*
Light (1-5 cigerettes per day)
Moderate (5-12 cigerettes per day)
Heavy (12-20 or more cigerettes per day)
Not at all
6) Do you drink?
*
Light
Moderate
Heavy
Not at All
7) How long did you keep your last health club membership while not using the facility?
*
1-12 months
1-2 years
2-5 years
8) Please list the habits you would like to change:
*
9) What are your physical goals? (please be specific)
*
10) When was the last time you were at your ideal physical shape?
*
11) What activities have you been participating in to achieve your goals?
*
12) What events in your life are coming up that will motivate you to reach your goals?
*
13) Why is it important to reach your goals now?
*
14) After reaching your goals, how will your life be different?
*
15) Over the past 10 years how many times have you started and stopped a nutrition and exercise regimen?
*
1-5
6-10
11-15
16-20
Too many to count
16) What external factors have derailed your progress in the past? (Check all that apply)
*
Time
Money
No facility
Procrastination
Lack of Support
17) In your own opinion, why did you fail to “stick with it”? (Check all that apply)
*
Discipline
Knowledge
Experience
Accountability
Lack of expertise
19) On a scale of 1 – 10, how serious are you about achieving your goals?
*
1
2
3
4
5
6
7
8
9
10
18) I would like to: (check all that apply)
*
Lose Weight
Gain Weight
Feel Better
Look Better
Live Healthier
20) Are there any other conditions (injuries, medical illnesses) that your trainer should be aware of?
*
If you answered yes to any of the above questions, please read the statement below.
If you answered yes to any of the above questions, please read the statement below. If you answered yes to any of the above questions, talk with your doctor before you become more physically active. Tell your Doctor your plan to exercise and to which questions you answer yes. If you honestly answered no to all questions you can be reasonably certain you can safely increase your level of physical activity gradually. If your health changes so you then answer yes to any of the above questions, seek guidance from a physician.
Checkbox
*
I have read the above statement, and agree.
Verification
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January 2021
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OUR TRAINING PACKAGES
30 Minute Training Packages
One-Hour Training Packages
Group Rate Training Packages
Platinum Trainer Package
Gold Trainer Package
Silver Training Package
Bronze Trainer Package
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