Consultation Form

Thank you for booking a consultation with Lucas James! In order to confirm your consultation, you must fill out this form or your appointment will be cancelled. All information is private and kept confidential.

Name *

First

Last

Address *

Email *

Phone *

Occupation *

How did you hear about us? *

What's your stress level on a scale 1(Low) to 10 (High)? *

Have you ever worked with a Personal Trainer or Registered Dietitian? If yes, please explain your experience. *

What are your top 3 goals? *

For Example: Lose 50lbs, Tone up, Get to 10% Bodyfat, Be healthy for my kids, Overcome Anxiety & Depression. Please be specific. Goals do not need to be physical goals.

What has stopped you from achieving your goal or sustaining it? *

For Example: Sustainability of the program, Need Accountability, Don't Know What To Do, Plateaued Then Gave Up

What would need to happen in one year for you to look back and think "This was the best decision I've ever made, I'm so grateful I did this?" *

Is your spouse or significant other supportive of your health goals? Do you need their permission to do things or can you make your own decisions for your health? *

Yes, I can make my own health decisions
No, I will need my spouse/partner/significant other and they will be with me at the consultation.

Please type the word "YES" in response to the following statements if you AGREE: *

I am a person who keeps my commitments and will show up on time to an appointment.

Are you willing to invest financially to reach your goals? *

Yes, I'm willing to make a financial investment in my health to reach my goals and change my bad habits.
No, I'm unable to make a financial investment at this time and understand my appointment will be cancelled.

Please type the word "YES" in response to the following statements if you AGREE:: *

I will confirm the appointment via text and email by responding "yes" or "no" that I will show up.

How soon are you looking to get started on a program? *

Custom Captcha: Required Security *

What is 7+4?

Please add the following numbers together to submit form. Thank You!

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