Join Cuong Strong

Date *

Name *

Age *

Email *

Phone Number *

Address *

Street Address

Street Address Line 2

City State

Zip Code

What is your goal? *

What is your current weight? What is your goal weight? *

What is holding you back from reaching your goal? *

When do you want to start training for your goal? *

What inspired you to contact Cuong Strong? *

Describe your current workout routine *

Describe your current nutrition *

Do you have any of the following conditions? If so, please explain

heart disease diabetes respiratory disease epilepsy/convulsions orthopedic conditions thyroid disorder gastrointestinal disorder other

Please explain any conditions related to your health

List all medications and/or supplements

Do you drink alcohol or use tobacco products? If so, how much?

Do you have any exercise limitations or food allergies? If so, please explain

What times are you available for personal training? *

Which plan are you most interested in?

1 on 1 Personal training & nutrition (1 session per week or 5 per month) ($270 for the first month then $235 for the next month) 1 on 1 Personal training & nutrition (2 sessions per week or 10 per month) ($490 for the first month then $440 for the next month) Exclusive gym membership ($70 for the first month then $50/month w/ training plan) Online training & nutrition ($270 for the first month then $235/month) Meal coaching ($170 for the first month then $120/month) Contest prep ($290 for the first month then $255/month) Red light therapy ($80-120/month)

How did you hear about Cuong Strong? *

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By submitting this form I agree, I have read, understand, and answered all the above questions fully and truthfully