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First name
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Last name
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Email
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Phone
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Please share your current health concerns/struggles, in order of importance.
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What is your ultimate long-term goal?
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What are you currently doing for your health, nutrition, and fitness?
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Have you tried anything in the past (or recently) to change your habits, your health, your eating, and/or your body? If so, what?
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Do you currently take any medications or supplements? If so, please list or link them below - the brand, dosage, etc.
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Have you worked with a Personal Trainer before?
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Yes
No
On a scale of 1-10 (10 being the most ready), how ready are you to commit to your goal(s)?
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If you answered less than 9 (<9), why didn't you answer higher?
I fully believe that if everything is not a "heck yes," it's a no. Let us know how you are feeling right now. :)
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Heck yes, I'm ready!
I'm ready, but scared.
Preferred way of contact?
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