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Fitness survey
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Indicates required field
When were you in your best possible shape?
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Under 18 years old
19-25 years old
26-35 years old
36-45 years old
Over 45 years old
How committed are you to being fit?
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Very committed
Somewhat committed
Not committed
Are you motivated to work out on your own?
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Yes
No
Do you have family and friends who actively motivate you?
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Absolutely
Somewhat
No, I'm flying solo
How many hours per night/day do you sleep?
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8+ hours
6-8 hours
3-5 hours
Less than 3 hours
Which best describes your body type?
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Popeye
Olive Oil
Whimpy
Current weight and height.
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Describe your eating habits over the last 3 days. Include as much detail as possible such as quantities, timing of meals and beverage choices.
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Describe your key objectives. Include any expectations you have around how long you think it will take to achieve your goals.
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Do you have any medical conditions, (heart disease, stroke, etc.) that would limit you from working out?
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Are you taking any beta blockers, or any other types of medications?
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Name
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First
Last
Phone Number
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Email
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