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Name:
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Surname:
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Phone:
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Email:
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Confirm Email:
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Age:
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What are your current goals?:
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Strength
Weight Loss
Weight Gain
Mobility
Pain Management
Get Control of Diet
What are you looking for in a coach?:
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Motivation
Accountability
Lifestyle Guidance
Expertise
How many steps do you get a day?:
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2-4000
5-7000
8-10000
10000+
Don՚t Know
How much sleep do you get per night?:
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2-4 hours
4-6 hours
6-8 hours
8+ hours
What is your number one struggle when it comes to improving your health, fitness, nutrition, strength, mindset, and/or overall well being?:
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What have you tried in the past that hasn't worked? *:
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How much time are you willing to commit to invest in your health in order to achieve your strength, fitness, and nutrition goals?:
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3 Months
6 months
1 year
This is a lifetime journey
How did you find me?:
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Anything else you want to share?:
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