Develop With Dee Intake Form

You can always press Enter⏎ to continue

Develop With Dee Intake Form

This is good. Let's get started. Complete this form.

10Questions

1
Name
First Name
Last Name
2
Email
example@example.com
3
Phone Number
Please enter a valid phone number.
4
So, let's talk about your habits...Select All That Apply
I'm up late at night.
I don't sleep well.
I snack a lot.
I'm not active.
I don't exercise much, or at all.
I don't like going to the gym.
I work a lot.
I eat fast food a lot.
I work out, but don't see results.
I don't like to cook.
I don't know what I should eat.
I walk a lot.
5
What do you consider a barrier between you and your goals?Select All That Apply
Time Management
Nutrition
Lack of motivation
Fear/Anxiety
Not Sure How To Start
Lack Of Support (Family, Friends, etc)
6
How important is making this this change in your life? On a Scale of 1 to 10 | 1 = Not Important | 10 = Extremely Important
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
7
What is the best time of the day for you to exercise?
Early Morning
Morning
Mid-Day/Afternoon
Evening
Late Night
I'm Not Sure
8
What are you looking to gain from this transformation?
Improved Health
Weight Loss
Mental Health
Muscle Gain
Tone/Definition
Education About Health
Nutritional Support
More Confidence
9
How confident are you in your ability to make this change happen?On a Scale of 1 to 10 | 1 = Not Important | 10 = Extremely Important
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
10
How ready are you to start making this change today?On a Scale of 1 to 10 | 1 = Not Important | 10 = Extremely Important
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
1
2
3
4
5
6
7
8
9
10
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6Row 0, Column 7Row 0, Column 8Row 0, Column 9
Should be Empty:

Question Label

1 of 10See AllGo Back