Health/Fitness Questionnaire

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Person to notify in case of Emergency

  • MM slash DD slash YYYY
  • Check if “YES” and Explain

  • Lifestyle Questions

  • Nutritional Habits: Please rate yourself using the following 3 factors.

  • Fitness Assesment

  • BF

  • Lunge

  • Hurdle

  • Twist

  • Leg Lift

  • Reach Behind



Fitness FX Radio


“Great Trainer to Work With”

I really enjoy working with Mike, he takes the time to know his clients. The workouts are designed with each individual in mind. Kettlebell workouts are great, he challenges you all the way while making sure you have proper form and technique during the whole set. Mike guides you through each and every move. He will keep you motivated to do your best! It is amazing that you can feel the difference within yourself so quickly! I always look forward to my next session.

By Beth Crossley / Pelham, NH