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Personalized Fitness Assessment Form
First name
*
Last name
*
Email
*
Phone
*
What is your daily level of physical activity?
Very active
Moderately active
Occasionally active
Not active
What are your health & fitness goals? Lose 20 Ibs? Be happy and healthy? Tone up? Balance your hormones? Increase energy? Feel more confident? Etc. (Explain in depth)
*
Explain to us WHY. What is driving you to make these changes?
*
What have you tried in the past and why hasn't it worked for you? What has kept you from achieving your goals?
*
On a scale of 1-5, how ready / committed are you to changing your life right now? (1 being "not ready at all" and 5 being "I'll do anything to change my life")
*
1 - I could put this off for awhile
2
3
4
5 - 1 want this change now!
NEXT STEPS. We will review your application and if we feel like we can truly help you, would you be opposed to setting up a quick 10-15 minute strategy call to see if this is the right fit?
*
Yes plz! I am READY to make a change
No thanks, I don't want 1:1 help I can do it on my own.
Submit
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