Potential Client Application
DANIELLE DELIKAT FITNESS LV
Name
*
First Name
Last Name
What is your birthday?
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
When is the best time to contact you?
*
How did you discover Danielle Delikat Fitness? (Referred by..friend, IG, FB, Fit Club)
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Do you live in Las Vegas? If not, then where?
*
What are your fitness goals? (be specific as possible)
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WHY do you want to achieve your goal?
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WHEN would you like to achieve your goal by? (Event or Specific Date)
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How motivated are you to achieving your goal? Scale of 1-10
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How many hours per week total are you willing to commit to working toward your fitness goals?
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What do you need the most help with?
Accountablility
Consistency
Regular exercise
Self-confidence & Mindset
Hit a plateau
Relationship with food
Habits outside the gym
How many days a week do you eat out?
1-3
3-5
5-7
never
Have you ever hired a personal trainer, fitness or wellness coach? If yes, how long did you work with him/her? Why did you have to discontinue?
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What are you currently doing for fitness?
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What do you believe are your greatest obstacles to reaching your goals?
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Do you have any injuries, mental or physical restrictions?
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Do you currently have a gym membership?
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Submit
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