Thank you for allowing me the
opportunity to help you achieve your weight loss and fitness goals.
The purpose of this initial consultation is to help me understand
your particular needs and goals and to explain in detail about how
my services can help you as an individual. For example, how much
weight you can expect to lose, the type of program I will design for
you, and so on. Weight loss is a serious issue because it concerns
your health. If you do something wrong it could cause irreversible
damage to your metabolism, thyroid, and entire system. I take my job
very seriously and I make sure you as my client will get the very
best in care when it comes to designing you a program and providing
the necessary support you will need throughout your entire weight
loss journey. The initial consultation is very simple. Fill out the
form below and I will be emailing you within 24 hours.
You will soon see why my personalized program has been rated one of
the top weight loss and fitness programs in the Country by many
fitness magazines and news media agencies. I care about you as an
individual and soon you will see the difference it makes.
Johnnie D Jackow Sr - Online Fitness Trainer
Certified Fitness Expert/Author
NOTE: Your participation does not obligate you in any way, and all
information submitted is kept strictly confidential.
Please select your body-type
Misc. Health Questions - Please check all that apply
On average, how many days per week do you
When I design your program how many days per
week will you be able to exercise
On the days you chose above how much time will
you have to dedicate to exercise
On average, what time of the day will you be
able to exercise
Customized Program Contents
Please select everything you would like included in your
For optimal fat loss resistance
training and aerobic exercise should be chosen for your workout.
Please choose any extras that you would like included in your
training & Aerobic Exercise
I will design a diet program that I feel will
work best for you based on this questionnaire form. However, I
can base your program on any of the below diets. Please select
one if you like (optional).
- Please explain below▼
Your diet plan
will be tailored to fit you. NOTE: Rather than eating 2 or 3
larger meals per day, in most cases 5 small meals per day is
optimal for fat loss. Please choose a meal plan below based on
your current time schedule.
Please choose any extras you would
like included with your customized diet program.
eating instructions when dining out
cleansing detox program
Body Wraps - instructions on how you can make body wraps in the
comfort of your own home. Lose inches, tighten skin, flush out
toxins and help smooth out cellulite.
Basic Information -
Step 5 of 5
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