Phone Call Registration
Application Form
Back To Basics 4 Life Fitness
Full Name (First & Last) *
Phone Number *
Email *
Age *
Preferred time to call? *
Occupation Stress Level *
Home Stress Level *
Are you currently undergoing exercise? *
How many sessions per week and what intensity? *
WEIGHT: What's your current weight and how much weight would you like to lose/gain in order to be happy? (answer both) *
FOOD RELATIONSHIP: What's your relationship like with food? (what are your food habits) *
LOST MONEY: How much (on average) do you spend per week on items that have helped contribute to your weight gain? Take Away, alcohol, petrol station snacks, deserts, ice-creams, supplements (fat-burners) *
Why did you apply and what makes you think I am the coach for you? *
Social media handle (Facebook or Instagram) *
NOTE: This is only an application form, so please ensure you fill out your answers as detailed as you can to give me the best understanding of you. As there are only limited spots available I want to ensure we are the right fit for you. Thanks from the B2B4LIFEFITNESS Team.
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