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Fit-Rx Pros Client Application
Please fill out all fields that apply. Please fill out a separate form for each Candidate.
Email *
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Name: First/Last *
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Phone Number: *
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Date of Birth *
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Height: *
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Current Weight *
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Heaviest Weight: (Not Pregnant) *
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Lightest Weight You Have Been:
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What is your ideal target body weight ? *
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Gender *
Tell us a little about your history with exercise/sports/fitness.
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Have you ever worked out in a commercial gym?
If so, where?
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Do you currently have a gym membership?
If yes, where?
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Do you require exercise programming for a home gym workout?
What type of exercise equipment do you have access to?
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What days can you execute your workouts? *
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Please provide a detailed description of your current exercise Regimen.
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Do you have any injuries or physical limitations we should consider when designing your exercise programming? *
Please provide as much detail as possible
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Are you currently taking any - medications? *
If yes, please list.
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Do you have any medical conditions we need to be aware of? *
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Do you have any food allergies?
If Yes: Please List
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Provide an example of a typical day of eating.
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Have you been on a "Diet Plan" before?
If so, please provide details.
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Do you take nutritional supplements?
If Yes, Please list:
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Please provide any helpful insights about your relationship with food.
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Tell us a little about your personality
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Why do feel our Coaching platform is what you need to succeed?
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Comments
Please use this field for any additional information you wish to give.
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