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4Star Fitness Information Form
4Star Fitness Information Form
Please answer the questions below and I look forward to connecting with you soon regarding your form!
First Name
*
Email
*
Where do you feel you need the most help in your journey? (Select all that apply)
*
Support, Encouragement, Motivation
Accountability
Guidance and Education
All of the above
How would you classify yourself in your health and fitness journey?
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I am a beginner, never been on a health and fitness Journey before
Starting back into my journey-It has been a while
Other- Please Explain
If other, please briefly explain
How would you classify your current lifestyle
*
Sedentary- No Exercise routine
Exercise routine 1 -2 times a week
Exercise routine 2-3 times a week
Exercise routine 3+ times a week
What seems to hold you back from reaching your health and fitness goals? (Select all that apply)
*
Procrastination (i.e: not setting priorities)
Always busy- (i.e: Travel, Job, Family)
No Structure/Routine
Barriers or Limitations (ailments, pre-existing injury, hormones)
Habits that are not supportive (junk food, bad relationships/stressful situations)
If you have any barriers/limitations, please briefly explain
Do you have a history of obesity, high blood pressure, cardiovascular disease in your family?
*
Father
Mother
Both
Neither
What is your age?
*
18-25
25-35
35-45
45-55
55+
What specific goals do you have that you would like to achieve? (Select all that apply)
*
Lose Weight
Reshape Body- Muscle Tone
Overall Health- More Energy/Feel Better
All of the above
Any additional comments you would like to share?
Date / Time
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