First & Last Name
Email
*
What is your main goal right now?
Lose weight
Lose belly fat
Build strength
Improve energy
What is your current weight and your goal weight?
How many days per week can you realistically work out?
1-2
3-4
5+
How many meals do you normally eat per day?
Do you struggle with cravings at night?
Yes
Sometimes
No
What areas do you want to improve the most?
Lower stomach
Back fat
Arms
Overall body
Do you currently do any cardio or walking?
Yes
No
Do you have any injuries or pain I should know about?
What time do you usually eat your first and last meal?
Why is it important for you to change your body right now?
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