Consultation Contact Form "*" indicates required fields Name of person filling out form* First Last Email* Phone*Who is interested in personal training?* Yourself Family Member or other What is your relationship to this person?*Name of family member or other person for consultation* First Last Address of person to receive consultation* Major Cross Streets City State / Province / Region ZIP / Postal Code Age*If you are contacting us on behalf of a relative or friend, are they agreeable to having a personal trainer? Yes No Unsure What are the best days/times for the consultation?*What are the goals?* Improve strength Improve flexibility Post rehab Pre-rehab Lose weight Improve balance Relieve joint pain Other Do you want to do the consultation via Zoom? Yes No Please provide a brief summary of any health conditions:*Would you like to subscribe to Fitting News from Lori Michiel Fitness? Yes, send it, Lori CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Your information is confidential and will not be shared outside of the Lori Michiel Fitness organization.