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Ashley Brown Fitness + Nutrition Remote Client Intake
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Email
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Your email
Name
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Your answer
Today's Date
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MM
/
DD
/
YYYY
What are your current physical goals?
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Lose weight/fat
Gain strength
Gain muscle
Aerobic Capacity (Cardio)
Improve overall physical fitness
Mobility
Injury Rehab
Improve athletic performance
Improve sport specific performance - list sport in "other"
Other:
Required
Please explain
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Your answer
What are your current lifestyle goals?
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Increased Energy
Increased Confidence
Increased Mental Clarity
Increased Overall Happiness
Decrease Stress
Improve Sleep
Improve Nutrition
Improve Digestion
Improved Relationships
Increased Libido
Other:
Required
Please explain
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Your answer
How would you rate your current fitness level?
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Novice
1
2
3
4
5
6
7
Superhero
If you are currently active, what exercise/activities do you typically do?
Your answer
How would you rate your current nutrition/eating habits?
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Unhealthy
1
2
3
4
5
6
7
Nutritional Olympian
Have you done anything in the past to try to change your body?
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Your answer
Which of those things have worked well for you?
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Your answer
Which of those things did not work well for you?
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Your answer
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