29again Qualifying Questionnaire Do you promise to answer all the questions below honestly? Question Title * 1. Do you promise to answer all the questions below honestly? Yes No Address Question Title * 2. Address Name Address City / Town State / Province ZIP / Postal Code Email Phone List 2 specific outcomes you want to achieve in the next 30 days while working with 29again Question Title * 3. List 2 specific outcomes you want to achieve in the next 30 days while working with 29again Outcome #1 Outcome #2 What or who could hold you back from reaching your desired outcomes? Please be specific Question Title * 4. What or who could hold you back from reaching your desired outcomes? Please be specific Are you willing to walk away from controllable factors, toxic relationships and tempting distractions that could inhibit your progress? Question Title * 5. Are you willing to walk away from controllable factors, toxic relationships and tempting distractions that could inhibit your progress? Yes, absolutely! I am, but it will be very difficult. I am not sure. I have failed before. Probably not. Is there an easier way? No. I lack willpower. What fitness goal did you try to reach in the past yet failed at? Why did you fail? Question Title * 6. What fitness goal did you try to reach in the past yet failed at? Why did you fail? What was your greatest success with achieving a health related goal in your life? Why did you succeed? Question Title * 7. What was your greatest success with achieving a health related goal in your life? Why did you succeed? What assistance could we provide for you that would drastically improve your chances of succeeding? Please be specific. Question Title * 8. What assistance could we provide for you that would drastically improve your chances of succeeding? Please be specific. When you achieve your desired goal will you let other people know where you received your fitness coaching and refer people for us to speak with? Will you help others find joy in being fit? Question Title * 9. When you achieve your desired goal will you let other people know where you received your fitness coaching and refer people for us to speak with? Will you help others find joy in being fit? Yes, absolutely! No I will not do that. Do you promise to do your best to keep your appointments and to follow instructions? Question Title * 10. Do you promise to do your best to keep your appointments and to follow instructions? Yes No See If I Qualify