First Name
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Last Name
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Email
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Phone
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Age
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31-39
40-49
50-59
60-69
70+
Other
How did you hear about us?
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Someone referred me directly
I know people who had great experiences at PowerStrength
Social Media
Online Search
Email
Radio/Podcast/TV Interview
Other
Which Health and Fitness Results Are You Looking to Achieve While Training With Us?
Get Stronger
Build Confidence
Have more energy
Live a more active lifestyle
Build lean muscle
Lose weight/unwanted body fat
Reduce pain
My doctor told me I needed to make some changes
Become healthier overall to increase longevity
Understand and develop healthy nutrition habits
Get in awesome shape for an upcoming event
All the Above
Other
What's stopped you from solving this yourself? What are the roadblocks that have kept you from hitting that goal after all this time? (Check all that apply)
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Making Time in my Weekly Schedule
Lack of expert Coaching and Guidance specifically tailored to my needs
Finding a Proper Training Program for my Needs
Lack of Energy
Putting the needs of others ahead of my own
Inconsistency with my Nutrition and Eating Habits
Not feeling comfortable in a fitness setting
Lack of a healthy support system and accountability
Nagging Injuries and Pain
All the Above
What types of things have you tried to solve this problem in the past? *Check all that Apply
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Private 1-on-1 Personal Trainer
Large Group Bootcamp Classes
24-Hour Gym/Health Club
At-Home DVD's and DIY Workouts
Diets/Supplement Programs
I can't remember the last time I did ANYTHING!!!
With your schedule, what is the most ideal time for you to exercise? Check All That Apply
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Early Morning (before 8am)
Mid-Morning (8:30am-12PM)
Late Afternoon/Evening (Between 4:30-7:30 PM))
Weekends
A combination of the above to hit my goals
My schedule is rather flexible
Choose Which PowerStrength Location Works Best For You:
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Alpine - 919 Alpine Commerce Park NW
Kentwood - 5131 E Paris Ave SE
Jenison - 1308 Rosewood St.
Plainfield - 5246 Plainfield Ave NE
Holland - 779 96th Ave
If needed, please tell us more about you and how we can best help you achieve your goals
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By Checking this box you acknowledge that you have completed this inquiry with intentions on improving your overall fitness, health, and well-being. You also acknowledge that after completing this page, you will follow the prompt to self-schedule a brief call with a PowerStrength representative to review how we can best tailor a program for your goals and needs. Note that space is often limited in our program. Those who schedule promptly have the best chance at the training slots that fit their schedule. We look forward to speaking with you!
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