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Jervis Fitness

Home
Personal Training
About Jervis
Testimonials
Register
E-Mail

Testimonials

"Working out with Jervis has changed my body. "

-Linda D. Schloss

"Overall my quality of life has improved!"

- Barbara Berliner

Get a Free Training Session

Fill out the form below and we will contact you within 48 Hours. (New York City area only)

Contact Information

First Name: *

Last Name: *

Email: *

Phone: *

Home Address:

City:

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Zip:

Additional Information

How did you hear about J.F. Private Trainers?:

You are interested in which center?:

Strength Training

Weight Management

Core & Flexibility

Select the schedule for training appointments that is best for you::

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Best time for a first workout?:

:

am

pm

Number of days per week with a trainer::

You are interested in which of our services?:

One on One

Team Training

Open Member

Exercise History

Persently? If yes, what?:

If yes, what?

Past? If yes, why did you quit?:

Worked with trainer? If yes, how long?:

Injury during activity? If yes, explain:

Nutrition

Presently Dieting?:

Breakfast?:

AM snack?:

PM snack?:

Alcohol serve/wk::

Caffeine serve/day::

Energy, Sleep, Stress

Energy Highs?:

Time?:

:

am

pm

Energy Lows?:

Time?:

:

am

pm

Insomnia?:

Sleep Interruptions?:

Fitness Goals:

Medical History

List Medications:

Other Prescription Medications? :

Diagnosed with Disease ?:

Orthopedic Limitations - check one if yes:

Yes

No

Bad Back:

Bad Knees:

Weak Ankles:

Shoulders/Neck:

Hips:

Please list any past orthopedic problems::

Yes

No

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