Full Name *

Email *

Age *

Gender *

• Female
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Do you have access to a gym? *

Yes

No

Can you briefly describe your specific, short-term goals (within the next 12 weeks)? *

How would you rate your current fitness level? *

• Poor
• Fair
• Solid
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Any health problems, strange issues, or general creakiness? *

Any dietary requirements? *

• Dairy Free
• Paleo
• Pescatarian
• Gluten-free
• Vegan
• Vegetarian
• Other
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What made you choose to apply for my online training programme? *

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