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Name

First Name

Last Name

Email

Tell me about yourself and your goals

How did you hear about me?

What are your current fitness habits?

Have you worked with a trainer in the past? If yes, what went well? What didn't go well?

Are you ready to financially commit to pursuing your goals?

Yes

No

Are you ready to change your current lifestyle in order to achieve your goals?

Yes

No

Are you applying for the 21 Day Challenge

Yes

No

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