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Contact Moxie In Motion

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Where we are

Moxie In Motion
@ Gold's Gym
360 Hampton Dr, Venice, CA 90291
424-279-8006
info@moxieinmotion.com

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Welcome to Moxie IN Motion- Ready to get started?!

Please fill out the form below and we will be in touch soon!

Please keep in mind space is limited. We aim to work only with the most committed clients who want to make progress and see change in all areas of their life. This is NOT a get thin quick program, but rather a lifestyle change. We aim for optimal health that leads to a lean, functional physique, full of energy and good vibes. That doesn’t mean endless grueling hours, but it does mean a desire for MORE. We only work with those ready to take on that challenge!

General:
First Name*
Last Name*
Phone Number*
Email Address*
Age
Please enter a number from 1 to 120.
Height
Weight
Sex
What kind of training are you looking for?
- Online training
- In-person training
Fitness:
What are your current health and/or fitness goals?
What do you currently do for movement and activity in your life?
What other things have you done in the past? (ie; yoga, Pilates, weights, running, sports, slackline etc..)
How often do you do these activities?
What obstacles do you foresee keeping you from those goals?
Have you worked out before?
- Yes
- No
What are your preferred days and times for working out?
Have you worked with a personal trainer or nutritionist before?
- Yes
- No
Work/Life Balance:
How many hours a week can you commit to bettering your health? This isn’t just hours spent in the gym, but hours spent at home cooking, taking walks, etc…
Please enter a number less than or equal to 168.
How many hours a week do you spend driving?
Please enter a number less than or equal to 168.
How many hours a week do you spend watching TV and going on social media (combined)
Please enter a number less than or equal to 168.
How many hours a week do you spend outdoors?
Please enter a number less than or equal to 168.
Is your job sedentary (scale of 1-10, 1 being very)
Please enter a number from 1 to 10.
What do you do for hobbies/fun?
Have you ever done breath work or meditation before?
- Yes
- No
Did we miss anything? Tell us more about yourself or ask us questions here:
Nutrition:

**If you hope to embark on a program with Moxie In Motion soon, please start to keep a DETAILED 3-5 day food journal. We will go over this when we meet.

Include for each day:
- Time you ate
- All relevant ingredients (chicken salad is not clear. 6 oz Grilled chicken on salad greens with olive oil and other veggies with croutons OR canned chicken with mayo are very different things)
- Portion Sizes to the best of your knowledge/abilities.
Send a copy?
- Yes, please send me a copy of this questionnaire.
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- Yes, please add me to your Newsletter list.
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