Pilot Group Coaching Program Interest form
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 What is your name?
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What is your email address? *
What age group do you fall in? *
What is your profession? 
What accomplishments are you proud of?
What are Your Health Goals (be specific) and why are they important to you?

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What is getting in the way of you reaching your health goals?
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What type of support do you feel you need the most to reach your health goals? (e.g., motivational, nutritional guidance, workout plans, stress management techniques)
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What are your main goals for wanting to join the "Thrive" program? (Select all that apply)
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Required
What is one thing you would want to experience by the end of this training?
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Have you participated in similar programs before? If so, what were the outcomes?
How much time can you realistically dedicate to this program each week?
Clear selection
How would you describe your current level of physical activity?
What are your main health concerns or challenges? (Select all that apply)
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Required
Do you currently have any chronic health conditions? 
If so, please describe.
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On a scale of 0-10, how committed are you to making lifestyle changes to improve your health and well-being? (0 being not committed at all, 10 being extremely committed)
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If selected, do you agree to commit to the full 90-day program and provide feedback to help improve future iterations of the program?
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This form was created inside of Journey to Health with Priya LLC.

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