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HEALTH AND FITNESS QUESTIONNAIRE
This intake form allows us to gather the critical health and personal information needed to plan for your upcoming meal and workout schedules. You are required to complete this form in order for your health project to start.
Personal information
Your Name
*
Your Surname
*
Phone Number
*
Date of Birth
*
Email Address
*
Gender
*
What type of program are you interested in
*
What type of program are you interested in
A
Weight - Loss & Fitness Program
B
Rejuvenating Health Program
C
Personalized Program
D
The Reset Retreat
E
The Pause (Mini Detox)
F
Elevate Your Routine
What date would you like to join the program
*
Do you have any chronic medical conditions?
*
Height
*
weight
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