Client Request Form Please complete the form below to book a session with us! We will be in touch with you shortly! Name Company Name Email Phone Number Address What type of service would you like to schedule with us? Senior Group Fitness- YogaSenior Group Fitness- ExerciseSenior Group Fitness- Zumba/DanceSenior Group Fitness- Tai ChiOne- on- One Personal Training and Companionship for SeniorsNon Senior Personal Training, In- Home, One- on- One Personal Training In the event that we are unable to provide your requested class above, which "back-up" class would work for you? YogaExerciseTai ChiZumba/DanceN/A Would you like classes to be seated, standing, or a combination of both? SeatedStandingBoth Seated and Standing What type of population will be participating? Independent LivingAssisted LivingMemory CareHealth and Rehab Center/Skilled Nursing55+ CommunityAdult day careSenior CenterNon-Profit Affordable Senior HousingIndividual SeniorIndividual Non-SeniorHotelCountry ClubApartment Complex - SeniorApartment Complex - Non-Senior INTRO CLASS: Specify the exact DATE and TIME of the preferred appointment. (Please book at least 7 days from today). INTRO CLASS: YOUR BOOKING IS NOT YET CONFIRMED! In the event that we are unable to book your preferred appointment, please provide us with two alternative dates and times. Please select the class duration you would like to book 45 min60 min2+, 30min classes (back to back)2+, 45min classes (back to back)2+, 60min classes (back to back)TBD Please select the desired frequency of recurring bookings 1x Per Week2x Per Week3x Per Week2x Per Month Please specify your ideal recurring or one-off schedule. What date would you like your recurring classes to begin? Are there special instructions for our trainers to be aware of prior to your appointment? What is the best email address to send invoices to? In case of an emergency, what is the best direct mobile phone number to reach you? Our intention is to book recurring classes/sessions with you. Are you looking to book with besttrainer.co.uk on a recurring basis 2x per month or greater after your intro class? NoYesUndecided Are you able to afford our rates on a recurring basis 2x per month or greater? NoYes Name of Sales Representative (optional)
