Intake Form

Welcome to our IGym Lifestyle (IGL) Application Form. Thank you for your interest in our program. Please answer every question completely.
It is important to remember that this program explores our mind and our lives through exercise. This is also a personal training course. We will be physically training you as well. This program will be fuses premiere exercise training regimen with group discussions and motivational strategies for engaging in a "whole health" perspective and lifestyle. Thanks again for your interest.

Best,
The Internal Gym Team

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* 1. General Information

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* 2. Evaluate the following reasons for wanting to enroll in The IGYM Lifestyle Program:

  Strongly Disagree Disagree Neither Disagree Nor Agree Agree Strongly Agree
I have a desire to learn to ways to combat mental limitation in life and in the gym.
I suffer from negative thinking and it prevents me from achieving my goals
I’ve hit a mental plateau
I’ve hit a physical plateau
I don’t have the motivation to stick to a program long enough to see results
I want the perfect body to show others
I’m insecure about my body
I seriously want to make lifestyle changes in my life and believe I am ready to stick to them
I'm generally dissatisfied with where my life is
I know I'm capable of so much more and want to tap into that
I like the idea of a holistic approach to exercise

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* 3. What motivated you to want to apply for this program?

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* 4. What prior experience do you have when it comes to exercise and nutrition?

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* 5. What prior experience do you have when it comes to self development courses programs or coaches?

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* 6. How serious are you about making the changes necessary to have the body you want and the mindset required to achieve it?

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i We adjusted the number you entered based on the slider’s scale.

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* 7. I am currently willing to invest my energy, time and money in a program that provides exercise training and education and self development training and education?

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i We adjusted the number you entered based on the slider’s scale.

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* 8. How many days on average can you dedicate to exercise per week?

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* 9. Describe your prior experience with life coaching of any sort (ie. Self-development books, a mentor, a life coach, retreats)?

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* 10. If you answered yes, how helpful (or not) were these experiences?

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* 11. In your own words what are your biggest obstacles when it comes to your health and over all well-being

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* 12. What are your primary goals for taking this program? What are you most excited about learning?

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* 13. Anything else that you’d like to share? 

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* 14. As the goal of this course is to truly improve physical and mental well being in everyone of our clients, information and lessons from this course can improve current research on exercise motivation and habit change. If selected for this program would you consider being apart of the research component of this course? (More information will be provided in the course.)

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* 15. It is important to note that some of these course lectures and or training sessions will be recorded for marketing purposes. Is this okay with you? 

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* 16. Are you willing to meet once weekly for the lifestyle and motivation component of this course.

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