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CONSULTING & PERFORMANCE

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First Name*

Last Name*

Email*

Phone Number*

Birthday*

Month

Day

Year

Height | Format: Feet-Inches (Ex: 5-10)*

Weight?*

Check All That Apply*

I'm a middle school athlete or younger

I'm a high school athlete

I'm a collegiate athlete

I'm a professional athlete

I'm a former collegiate or professional athlete

I want to lose weight

I want to gain weight

I want to gain muscle

I want to get in shape

I want to run faster

I want to be more explosive

I want to improve my quickness

I want to improve my balance/body control

I want a flat stomach and/or abs

I want a bigger and/or rounder butt

I workout, but I don't know what to eat

I go to the gym, but my workouts aren't effective

I'm an athlete looking to improve my performance and overall athleticism

I feel sluggish and want to improve my daily productivity and performance

I need to train for a specific event (Ex: 5K, Marathon, Triathlon, Tough Mudder, etc.)

I need to train for a specific sport (Ex: Football, Basketball, Baseball, Soccer, Track, etc.)

I have previous health conditions and/or injuries that still require attention

None of the above

On a scale of 0-10 with 0 being barely alive and 10 being totally fit, how would you rate your fitness level?*

On a scale of 0-10 with 0 being terrible and 10 being perfect, how would you rate your nutritional intake?*

On average, how much sleep do you get a night?*

What's Your Ultimate Goal?*

Preferred Start Date?

Month

Day

Year

CHOOSE YOUR WELLNESS PROGRAM

Getting By$150

Getting Better$300

Peak Performance$500

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COOL is YOU!

STAYCOOL LLC

P.O. Box 6110 | Elkins Park, PA 19027 | United States

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