Assessment

Once you complete and submit the form, you will receive a message stating: “Your responses were successfully submitted. Thank you! Please add coachrob@laganafitness.com to your email safe list.”   If you do not see this message, I did not receive your form. Please contact me at coachrob@laganafitness.com directly. Thank you.

Initial Client Assessment

Initial Client Assessment

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Contact Info

Please add coachrob@laganafitness.com to your email safe list. Once you have completed the form, I will contact you.

Please separately send any photos you wish to include to coachrob@laganafitness.com (e.g Front, Back and Side Views)

Which service are you interested in ?

Wholistic Gold - Quick Start

Wholistic VIP - Road to Fitness, Heath & Wellness

Pantera Bikini Champion Program

Pantera Wellness Champion Program

Click on Coaching Packages in the top menu for more info.

Full Name *

Mobile Number *

Email Address *

How would you like to communicate for your free consultation booking? *

Phone

WhatsApp

Signal

FB Messenger

Email

Zoom

Google Meet

How did you hear about us or whom has referred you ? *

Stats

Your Age *

Height (ex: 5 feet, 5 inch) *

Current Weight (in pounds) *

Lowest Ever Weight (in pounds) *

Highest Ever Weight (in pounds) *

Where do you carry stubborn/hard to lose body fat? (ex: lower abdomen, flanks/love handles, under arm, etc.) *

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