Name:
*
Email:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
*
Time Zone ( for phone interview scheduling)
*
What are your top three goals to achieve with your customized fitness training plan?
*
What is your history with fitness training?
*
What type of success have you had in the past with fitness training? List what worked and what did not work?
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Do you have any known injuries or areas of concern?
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Yes
No
If yes, please describe in detail below.
Are you aware of any condition you have that may prevent you from undertaking a fitness program?
*
How committed are you to achieving your fitness training goals above?
*
Please Select
I'm just starting to research options
This is not my top priority but close
I'm 100% committed, lets do this!
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