Client Intake
Strength Testing for Longevity Medicine
First Name
*
Last Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zipcode
*
Age Range
*
Please Select
Under 30
30-39
40-49
50-59
60-69
70+
What brings you here?
*
I want to understand my baseline strength
I want specific goals and a plan to reach them
I am focused on longevity and healthspan
I am recovering from an injury or surgery
How would you describe your current activity level?
*
Mostly Sedentary - little to no structured exercise
Lightly Active - some walking or occasional activity, nothing structured
Moderately Active - exercising 1-2 times per week
Regularly Active - structured exercise 3-4 times per week
Very Active - training 5+ times per week with intention and consistency
Anything else you would like to share about your health or fitness situation?
*
I agree to be contacted about this program via email and phone
*
Agree
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