29again Qualifying Questionnaire Question Title * 1. Do you promise to answer all the questions below honestly? Yes No Question Title * 2. Address Name Address City / Town State / Province ZIP / Postal Code Email Phone Question Title * 3. List 2 specific outcomes you want to achieve in the next 30 days while working with 29again Outcome #1 Outcome #2 Question Title * 4. What or who could hold you back from reaching your desired outcomes? Please be specific 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. Question Title * 6. What fitness goal did you try to reach in the past yet failed at? Why did you fail? Question Title * 7. What was your greatest success with achieving a health related goal in your life? Why did you succeed? Question Title * 8. What assistance could we provide for you that would drastically improve your chances of succeeding? Please be specific. 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. Question Title * 10. Do you promise to do your best to keep your appointments and to follow instructions? Yes No See If I Qualify