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