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Name *

First Name

Last Name

Phone Number *

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Gender

Male

Female

Prefer not to say

What are your goals? *

Select all that apply

Fat loss

Weight loss

Tone up

Build strength

Build muscle

Muscle definition

Increase fitness level

Maintain current fitness

How committed are you to hitting your goals? *

Highly motivated

Motivated

Neutral

Unmotivated

Unsure

What stops you from hitting your goals? *

Select all that apply

Eating habits

Consistency in the gym

Consistency with food

Alcohol consumption

Lack of motivation

Time

Accountability

Health issues/injury

Other