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1
Name
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First Name
Last Name
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2
Email
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example@example.com
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3
Height
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4
Weight
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5
Gender
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6
Age
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7
Body Fat % and/or Measurements (not mandatory if unknown)
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8
Goal(s), be specific. Not just I want to lose weight. Why do you want to lose weight? What’s your why?
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9
Do you have any current injuries that may affect you from participating in any physical activity? (Yes/No) If yes, please list.
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10
Have you had any past injuries or surgeries that may affect you from participating in any physical activity? (Yes/No) If yes, please list.
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11
Are you currently taking any medication that may affect you from participating in any physical activity? (Yes/No) If yes, please list.
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12
Do you have any other condition that may affect you from participating in any physical activity? (Yes/No) If yes, please list.
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13
Do you have any food allergies? (Yes/No) If yes, please list.
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14
Do you have Access to a Gym?
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15
Do you have weights/fitness equipment at home? (Yes/No) If yes, please list
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16
What type of work do you do (desk job where you sit most of the day/manual labor work)?
*
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17
What is your exercise/training experience? *
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