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Name *Age *Select Age18-3536-4950-6566+Height (Feet)InchesWeight (lbs)What are your fitness goals?i) I'm in shape and I'm interested in improving my performance.ii) I'd like to lose weight.iii) I'd like to increase my muscle mass.iv) Something elseWho do you want to get in shape for?i) Myself: My goals around fitness are specific to me.ii) My kids / Grandkids: I want to be able to run after them without losing my breath or just be around to see them have children of their owniii) Someone else6. When was the last time you felt “Fit”?i) I am fit today.ii) Recently.iii) Over a year ago, but within the past 5 yearsiv) Over 5 years agoHow much time and effort are you willing to put in?i) More than 5x a weekii) 3x to 4x a weekiii) 1x to 2x a weekiv) Less than once a weekDo you have any health issues/Injuries/Restrictions that could preclude you from following an exercise routine?i) Yesii) Noiii) I do not wish to provide this informationiv) Nothing. I am an athlete and want to improve my performance.What has held you back in the past?i) I've made temporary changes in the past but nothing ever really “stuck”ii) I am just. too. busy.iii) I've never learned the best way to reach my goalsEmail *Phone Number *Help me reach my fitness goals!