BUILD PLUS PLAN * First Name Last Name GENDER FEMALE MALE OTHER Date of birth * MM DD YYYY HEIGHT * weight * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Occupation: (This information helps gauge your activity level outside of planned exercise, including unpaid work and study.) EMERGENCY CONTACT NAME * RELATIONSHIP * PHONE * GENERAL PRACTITIONER'S NAME * GENERAL PRACTITIONER'S PHONE * GENERAL PRACTITIONER'S CLINIC NAME * GENERAL PRACTITIONER'S CLINIC ADDRESS * Would you like to include any of the following methods to help track your progress? (Please select all that apply) * This is optional, but it can offer valuable insights into your journey. Circumference Measurements Progress Pictures Bodyweight Calories (myfitnesspal) Steps None Your plan includes a personal training session. We’ll do our best to accommodate your preferences. Please enter your preferred day and time below: Additional sessions may be available upon request for $60 per session. Please enter your preferred days and times below: What days would you prefer to train on your own? * Where would you prefer to train when you're not training with a personal trainer? * Gym Home I only want to train when I'm with my personal trainer. Please list at-home equipment * At-home equipment is not essential to start, but can be incorporated into your training if available Have you followed any fitness plans before? * YES NO If yes, please list below: Have you followed any diets before? * YES NO If yes, please list below: Please note any suggestions or personal considerations you may have in working with DLVR. Thank you! DLVR will be in touch as soon as possible.
