Contact Information
Name *
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Date of Birth *
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Email *
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Phone number
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How did you hear about us? *
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If you were referred, who referred you?
(Skip if not applicable)
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What made you start to think about your health TODAY? *
Why not last month or last year?
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What is your main objective(s) for seeking a coach? *
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How do you picture your ideal lifestyle? *
3 to 5 years from now.
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Which training style do you thrive best under? *
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What do you do for a living? *
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Is what you do for a living, sedentary or active? *
What part of it is stressful?
If no stress is perceived, awesome! Leave it blank.
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What is your current routine? *
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Do you have any prior movement experience? *
If yes, what did you do and for how long?
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On a scale of 1-5 (1 being poor and 5 being good), rate your current state of health and wellness *
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Justify your rating above. *
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On a scale of 1-5 (1 being poor and 5 being good), rate your current nutritional habits. *
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Justify your rating above. *
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List your Top 3 Life Goals that you would like to currently focus on.
Can be both fitness and non-fitness related (1-5 year goals)
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Goal #1 *
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Goal #2 *
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Goal #3 *
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