Full Name
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Email
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Phone
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Current Weight
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Do you have any medical conditions you wish to disclose? (I.E. diabetes, hypothyroid, high cholesterol, etc)
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Goal Review Section
What is your primary fitness/weight loss goal?
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Weight Loss (more than 20 pounds to lose)
Performance (optimize my performance for a sport)
Build Muscle (build lean tissue to improve body composition and strength)
Health/Longevity (I want to live my life the best way possible. I want to feel my best!)
Aesthetics (I just want to look good naked! I have an event coming up I want to prepare for)
Other
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If you had a magic wand and could lose any amount of weight, what would that be?
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Why is it important that you reach this goal?
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Have you done 1 on 1 nutrition coaching before?
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What has prevented you from losing body fat in the past?
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Are you ready to stop playing small and start seeing results?
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YES
NO
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