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PERSONAL DETAILS
Full Name
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Email
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Phone
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What's your age?
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Age
18-25
26-35
36-45
46-55
56-65
66+
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Occupation
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HEALTH / FITNESS EVALUATION
I am happy with my current health, fitness and body
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Your rating (1-5)
1 - Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
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Is there anything in the next 6 months that would stop you from going all-in on this transformation (work, holidays, financial commitments, etc.)?
No
Yes
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Do you make decisions on your own or do you need a partner’s approval before investing in your health?
Yes
No
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Are you willing to follow structure, check in weekly, and be held to a higher standard than you hold yourself?
Yes
No
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I am ready to invest financially, emotionally and physically into my health & fitness journey
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Your rating (1-5)
1- Strongly Disagree
2 - Disagree
3 - Neutral
4 - Agree
5 - Strongly Agree
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What's going on with your life right now? Why have you considered getting help from me?
We're really exclusive, what makes you feel like you're the right fit for our program?