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* 1. Contact information

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* 2. Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?

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* 3. Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e. diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anemia, epilepsy, respiratory ailments, back problems, etc.)?

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* 4. Do you currently take any medications that may affect your ability to exercise? If so, list what.

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* 5. What is your fitness goal? BE SPECIFIC (SMART goals)
S= Specific (Provide details, how long, how much etc.)
M= Measurable (How will you measure whether you’ve reached your goals)
A= Attainable (Be realistic, set smaller goals)
R= Rewards-Based (Attach a reward to each goal)
T= Time Frame (Set specific dates for goals)

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* 6. Please indicate what time(s), date(s), and location (if applicable) you are available. *This will help me fit you into my schedule so please be considerate!

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* 7. How long do you want your 1-to-1 session to be?

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* 8. What is your current fitness level? Please be honest. *rough estimates

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* 9. Do you understand that I am NOT a certified personal trainer/nutritionist and that my service is solely based on my experience and personal research?

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* 10. Anything else I should know or want to tell me?

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