CLIENT APPLICATION
Thank you for your interest in the coaching programs at Fired Upp Fitness. Please complete the questions below and then we'll set up a complimentary consultation call to discuss your goals and how we may work together to achieve them. (Your information will always be confidential.)
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Today's Date
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First Name
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Your answer
Last Name
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Your answer
Address
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Your answer
City
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State
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Your answer
Zip Code
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Your answer
Email
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Your answer
Cell Phone Number
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If you'd prefer not to use your cell phone or do not have one, please write N/A.
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Home Phone Number
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If you'd prefer to use your cell phone, please write N/A.
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Emergency Contact First & Last Name
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Your answer
Emergency Contact's Phone Number
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Birthday
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Height
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Your answer
Current Weight
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Your answer
Goal Weight
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Your answer
Body Frame
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Small (when grabbing your opposite wrist, you can overlap your thumb and middle finger)
Medium (when grabbing your opposite wrist, you can touch your thumb and middle finger)
Large (when grabbing your opposite wrist, your thumb and middle finger do not touch)
Body Fat: Where do you tend to carry most of your weight/body fat?
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Evenly throughout most of body
Belly
Thighs/butt
Relationship Status
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Single
Married
Divorced
Do you have any children?
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Choose
0
1
2
3
4
5
6
Do you have any pets?
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Dog
Cat
None
How did you hear about Fired Upp Fitness?
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Examples include referrals, Facebook, or an internet search. If you heard about Fired Upp Fitness through a referral, please provide the first and last name of the person below.
Referral
Internet Search
Facebook
Instagram
Pinterest
YouTube
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If you were referred by someone, who referred you?
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What kind of coaching are you interested in or have you purchased? (Check all that apply)
*
1:1 Online Coaching -- Fitness and Nutrition
1:1 Online Coaching -- Nutrition Only
1:1 Online Coaching -- Workouts Only
Group Online Coaching -- Mom Bod Tune Upp (9-Week program)
In-Home Coaching (Kansas City area only)
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