10-Week Challenge - Client Intake Form 
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Email *
Full Name *
Phone Number *
How did you hear about our us? *
Gender - Female *
Date of Birth *
City *
If you plan on doing our Group Training 10 -Week Challenge workouts, what are the ideal days and times you are looking to attend? *
WORKOUT HISTORY- What is your current workout history?  What type of workout are you doing now? What do you feel might be missing that you'd like to include?   *
HEALTH / MEDICAL - Are there any health concerns, medications or injuries that we need to know about? *
List your emergency contact person, relationship & their cell phone number: *
GOALS / CHALLENGES - What are 3 of the most important goal you want to achieve? Why is this so important to you right now?  What is the biggest obstacle that you need to overcome to make this happen? *
What do you do for a living? *
FITNESS - How would you rate your current level of fitness? *
NUTRITION - How would you rate your current eating habits? *
STRESS - How would you rate your current level of stress? *
SLEEP - How would you rate your current quality of sleep? *
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