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What is your name? (First|Last)
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I am interested in learning more about: *
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What are your current health and fitness goals?
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How will you FEEL when you accomplish your goals? *
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How much time per day are you willing to work on your goal? *
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Are you willing to do something different to make a change? *
Do you currently have a coach?
Anything else you want to include and tell me : ) You can't share too much I promise!
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