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⚒️ Paterium Intake Form
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✦ Section 1: YOU
What’s your first name?
What’s your email address?
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How old are you?
What’s your height? (In feet/inches or cm)
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What’s your weight? (In lbs or kgs)
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✦ Section 2: YOUR MISSION
What is your primary fitness goal?
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What is your primary fitness goal?
A
Build strength and muscle
B
Lose fat and get leaner
C
Improve conditioning and mobility
D
Become more disciplined and consistent
E
Other
How many days a week can you realistically train?
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How many days a week can you realistically train?
A
2 days
B
3 days
C
4 days
D
5 days
E
6+ days
What type of training do you prefer? (Choose up to 2)
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What type of training do you prefer? (Choose up to 2)
Strength (Weight/Resistance)
Bodyweight / Calisthenics
High Intensity / Conditioning
Boxing / Striking Drills
Mobility / Stretching
I’m not sure
Where will you train?
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Where will you train?
A
At home
B
In a gym
C
Outdoors
D
Mixed
What equipment do you have access to?
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What equipment do you have access to?
Bodyweight only
Kettlebells
Dumbbells
Barbell / Plates
Resistance bands
Pull-up bar
Sandbags / Heavy objects
✦ Section 3: YOUR PATH
What archetype most resonates with you right now?
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What archetype most resonates with you right now?
A
Warrior - I want to fight, sweat, and overcome
B
Guardian - I want to protect, endure, and provide
C
Sage - I want to train my mind and body with purpose
D
Centurion - I want to lead with strength and wisdom
E
I don’t know / Let the system decide
Do you have any injuries or limitations we should consider?
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Do you have any injuries or limitations we should consider?
A
None
B
Yes
Please describe your injury or limitations
What do you want to feel like in 90 days?
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✦ FINAL STEP
Are you ready to begin?
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Are you ready to begin?
A
Yes. Let’s go!
B
Not yet. I’m still gathering myself.
Submit