First Name*
Last Name*
Phone*
Email*
What is your #1 fitness goal? *
What's preventing you from achieving that fitness goal?*
How long have you been working towards this goal?*
How much money have you spent working towards your fitness goals?*
How does this make you feel?*
On a scale 1-10, how do you feel about your body?*
1
2
3
4
5 I'm fine, but I don't like seeing myself in pictures
6
7
8
9
10 I'm basically Beyonce at the Grammy's (Flawless)
On a scale 1-10, what's your energy level today?*
1
2
3
4
5 Difficult getting up, I need caffeine
6
7
8
9
10 I have great energy
Why Did you fill out this form today? Be Detailed *
What fitness programs have you tried in the past?*
Why should we choose you for our program?*
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