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909-705-0562
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First Name
Email
Phone
Age
What are you trying to achieve through personal training?
What experience, if any, do you have working out?
Do you work out now? If so, how often?
Any current medical conditions?
Any chronic pain? (Knees, back, feet, etc.)
Any past injuries or surgeries? If so, when?
Any specific movements you are unable to perform because of an injury/disability?
Do you drink or smoke?
Drink
Smoke
Both
Neither
Do you need help with diet/nutrition?
Yes
No
Are you open to taking supplements (protein, creatine, pre-workout, etc.)?
Yes
No
What days of the week are you available to work out? (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time of day are you available to work out? (Check all that apply)
Morning
Afternoon
Evening
Are you open to group training?
Yes
No
How soon are you able to start training?
Anything you would like the trainer to know?
What is your preferred method of contact?
Call
Text
Email
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