New Client Application
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Email address
*
Your email
Name
*
Your answer
Phone Number
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Your answer
Gender
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Female
Male
Age
*
Your answer
What is your biggest goal?
*
Your answer
How Committed are you to reach your goal
*
Don't really care about my health
1
2
3
4
5
I'm all in and ready to change!
Are you financially ready to invest in yourself, today, in order to reach your goals?
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Yes
No
What is your biggest obstacle keeping you from reaching your goals?
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Your answer
Have you ever worked with a Personal Trainer/Health Coach?
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Yes
No
Do you have any injuries or health issues that I should be aware of?
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Your answer
How did you hear about me?
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Your answer
Would you like to be added to my mailing list to receive tips for staying fit & eating well while living a busy life?
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Yes
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