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Information Form

Name

Email Address

Phone

Age

Height/Weight

What is your overall fitness experience?

What are your top fitness goals?

What does success look like to you upon reaching your fitness goals?

What has gotten in your way from achieving your goals?

Are you ACTUALLY willing to put in the work for a better life?

What else do I need to know: any injuries, medical issues or underlying healt issues of any kind?

Describe your ideal coach

Are you willing and able to commit to investing in your health and lifestyle based on one of the program packages I currently offer? Are you willing and able to commit to investing in your health and lifestyle based on one of the program packages I currently offer? Yes No

15 + 5 =

You should be in good physical condition and able to participate in the exercise.
It is advised that you check with your health professional before engaging in any exercise or exercise program.

If you think you are having a medical or health emergency, call your healthcare professional, or 911 immediately.

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Push Harder Than Yesterday Your Solutions Moving Better And Feeling Different