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Welcome to your first step towards a long and healthy life!
First Name
Last Name
Age
Email address
Phone number (optional)
How often do you and your doctor discuss diet and exercise in detail?
Your filling out this application because of any/all of the following: You want to reduce your risk of heart disease, you want to lose up to 25lbs in 12 weeks, you want to improve muscle tone and strength, you want to keep up with your kids, you're sick of feeling tired all the time.
Yes - I am committed to improving myself for me and my family.
No - I am not ready to change my life for the better.
Your number one goal is...
Weight loss
Improved overall fitness
Improved energy
Reduction in heart attack risk
What are your biggest barriers to exercise?
Time
Knowledge about what to do
Accountability
Other:
Please list barriers:
How serious are you about taking the necessary action to reach your goals?
Somewhat serious
Serious
Very serious, can we start today?
If you were to find a way to reach ALL of your goals and learn how to keep your results FOREVER, would you be willing (and able) to invest in getting the necessary help to get there?
Yes, I am ready to invest in myself.
No, I have other priorities that are more important than my health.
Submit
Thanks for submitting!
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