First Name
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Last Name
*
Phone
*
Email
*
Date of birth
Height
Current Weight (lbs)
Fitness Goals (EX: build muscle, lose weight, maintain, size, definition)
What is your daily activity level?
Sedentary (little to no exercise, desk based job)
Lightly Active (light exercise, 1-3 days per week)
Moderately Active (moderate exercise, 3-5 days per week, jogging, cycling, swimming)
Highly Active (moderate to vigorous exercise or sports 6-7 days per week, includes running or sports)
Extremely Active (vigorous training 2 times per day, job requiring hard physical labor)
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What date would you like to achieve your goal by?
On a scale of 1-10, how important is this health journey to you?
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