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12 Week Challenge
First name
Last name
Age
Gender
Do you have any injury concerns
Have you had any surgery in the last 2 years?
Have you had any heart problems?
Do you have diabetes or epilepsy?
Are you taking any medication that may affect your ability to exercise?
Do you have any other problems that may affect your ability to exercise?
Are there any dietary or lifestyle vices that you would like to cut down/out moving forward?
Is there any dietary or lifestyle vices that you enjoy and are not interested in giving up?
Weight Goal
Goals: List as many as you like
Estimated Weight
Work Activity
Current Exercise
Exercise Preference
Resistance Training Technique Knowledge
Food Intolerances or allergies
Dietary Requirements
Is there anything already in your exercise schedule that you want to continue?
Do you know your estimated steps you complete each day?
Do you have any travel or holidays in the 12 week period?
Anything else you would like to add?
By typing your name below states that the above information provided is true and correct
Submit Now
Thanks for your details. Ill be in contact soon!
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