Mind, Body, Spirit Wellness Group
Please take a few minutes to fill out this form. The more I know about you, the better I can help you reach your goals.
Phone Number
Your answer
Name *
Your answer
Email *
Your answer
In which program are you interested? *
What are you currently doing for exercise, if anything? Do you have any injuries or limitations to consider? *
Your answer
What type of exercise do you enjoy? *
Check all that apply.
What does a typical day of eating look like for you? *
How many times/day do you eat? Are you on a regular schedule with your meals, or do you eat when you can? Do you ever skip meals?
Your answer
What are your current health and fitness goals? *
Your answer
What is your biggest struggle in reaching your goals? *
(Finding time to workout, proper nutrition, etc.)
Your answer
Do you have high cholesterol, diabetes, or any other health issues? *
Please explain.
Your answer
What is the best way to contact you? *
Is there any additional information I should know about you? *
Your answer
Do you currently have a Beachbody Coach with whom you're working? *
Your answer
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