Custom Workout Intake Form - Senior Fitness With Meredith

Please fill out this required form after you have successfully placed your order so our team can start processing your custom seven day workout plan from Meredith. Please be as descriptive as possible so we can be better prepared to create a plan that works for you.

Once submitted, you should be receiving your custom 7 day plan emailed to you within 1 week (7 days) from Meredith.

Note: If you have any issues submitting your form you can also download here as a PDF or Word Doc to fill out and email back to us.

If you have any questions or concerns please let us know by emailing us at meredith@seniorfitnesswithmeredith.com

Thank You! – Team Meredith

Note: For the open paragraph questions below, please be as detailed as possible where applicable.

Name (Required) *

Your Order # (Required - Found on your email receipt after purchase) *

Have you ordered a custom workout from Meredith before? (Required) *

Email (Required) *

Age (Required) *

Gender (Required) *

Your Height (Required) *

Your Weight (Required) *

How would you describe your level of physical activity in a given week? (Required) *

City, State & Country (Optional)

Approximately how many times a week do you currently exercise and what is the normal duration?

Please list any current physical, physiological or health related limitations you currently have.

Please list any exercises you are prohibited from performing (via doctor or physician recommended etc).

Please list any assistive devices you currently use if any (wheelchair, walker, cane etc).

Please list any exercises that you ENJOY and would like INCLUDED in your plan.

Please list any exercises that you DO NOT ENJOY and would like EXCLUDED from your plan.

Please list any workout equipment or exercise spaces that you currently own or have access to. (Dumbbells, resistance bands, walking/jogging path, living/bed room, pool etc.)

Please share some of your fitness or health goals with us so we can better understand what you hope to achieve with this custom 7 day workout plan from Meredith

Please list your preferred level of exercise: BEGINNER, INTERMEDIATE, ADVANCED or combinations of each.

Is there any additional information you'd like to share with us?

Agreement *

Required

Upon submitting, you are agreeing to our terms and disclaimer (opens in new window) regarding exercising at your own risk.