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Become A Client
Please fill out the following questions and I will get in touch with you as soon as possible. My aim is to help you gain body confidence and lead a healthier lifestyle dealing with both training and nutrition.
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1
Name
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2
Gender
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3
Date Of Birth
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Date
Day
Month
Year
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Age
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5
Job Description
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Email
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example@example.com
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7
Phone Number
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8
Do you have any medical conditions? (If so please state below)
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9
If you are on any medication please list them below
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10
Do you have any current injuries? (If yes then specify below)
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11
Is stress affecting your daily lifestyle?
*
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YES
NO
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12
Give a brief description of your diet on a daily basis
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13
What are your short term goals?
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14
What are your long term goals?
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15
How many sessions a week are you willing to commit to?
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1
2
3+
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16
Is exercise a part of your daily lifestyle?
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YES
NO
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