HEALTH, WELLNESS & FITNESS APPLICATION
Thank you So much for taking the time to fill out this form. YOU have taken the first step to making a LIFESYLE change. I'm a former teacher turned to a fitness professional, I lead a health and wellness community dedicated to providing fitness and nutrition support. Im very excited that you have chosen to take a leap of faith and decided to inquire about health and wellness. This survey will help me better understand your specific goals and needs and I'm happy to help YOU reach your potential. Go ahead and fill out these questions to the best of your knowledge and feel free to ask me anything that is on your mind. I'm here to help.
Name
First Name
Last Name
Email
example@example.com
IG Handle
What Platform Would You Like To Communicate On?
Email
Instagram
What Is Your Fitness Level?
Beginner
Intermediate
Advanced
Are You Interested In Doing Live Workout Classes?
Yes
No
Where Is Your Mindset Currently As You Prepare To Start Your Health & Wellness Journey?
I'm committed to getting the results but I'm on a tight budget
I am ready to put my excuses aside and go ALL IN!!
Are You Looking For A Short Term Program Or A New Healthy Lifestyle?
Short Term Program
A New Healthy Lifestyle
What Is Your Goal?
Weightloss
Toning/Muscle Building/Strength/Endurance
Nutrition
Weight Gain
Other
What Do You Struggle With The Most?
Where Are You From?
Canada
USA
UK
France
Other
How Soon Would You Like To Start
As Soon As Possible
Next Month
Is There Additional Information I Should Be Aware Of?
Submit
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