*1.What is your first and last name?(Required.)

*2.Phone Number(Required.)

*3.Email(Required.)

4.What services are you looking for?

5.What are your fitness goals?

6.What physical activities and hobbies do you currently participate in? (Ex. basketball, golf, etc)

7.Do you have any injuries, chronic pain, or underlying health conditions? Please explain. (ex. broken bones, past surgeries, diabetes, heart issue, problems with dizziness etc)

8.Are you taking any medication for your health? Or have physical limitations based on a medication you are on?

9.What is your commitment level from 1-10? (1 is unmotivated and 10 is committed and ready to start tomorrow!)

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