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Intake form
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Name
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Email address
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What is your age?
What is your gender?
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Male
Female
What are your fitness goals?
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Weight loss
Muscle gain
Improved endurance
Increased flexibility
General health
What is your current fitness level?
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Beginner
Intermediate
Advanced
Do you have any medical conditions or injuries?
What type of exercise do you currently engage in?
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Cardiovascular
Strength training
Yoga
Pilates
Sports
None
How many times a week do you currently exercise?
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0-1
2-3
4-5
6-7
What is your current diet like?
Have you worked with a personal trainer before?
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Yes
No
If yes, what was your experience?
Which service or services are you interested in?
Please select at least one option.
Nutrition-Only package
Personal Training-Only package
Combined package
Additional questions or comments
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