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Phone Call Registration
Application Form
Back To Basics 4 Life Fitness
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* Indicates required question
Full Name (First & Last)
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Age
*
Your answer
Preferred time to call?
*
Morning 9am - 12pm
Afternoon 12pm - 3pm
Evening 3pm - 6pm
Occupation Stress Level
*
Low
Medium
High
Home Stress Level
*
Low
Medium
High
Are you currently undergoing exercise?
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Yes
No
How many sessions per week and what intensity?
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Your answer
WEIGHT: What's your current weight and how much weight would you like to lose/gain in order to be happy? (answer both)
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Your answer
FOOD RELATIONSHIP: What's your relationship like with food? (what are your food habits)
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Your answer
LOST MONEY: How much (on average) do you spend per week on items that have helped contribute to your weight gain? Take Away, alcohol, petrol station snacks, deserts, ice-creams, supplements (fat-burners)
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Your answer
Why did you apply and what makes you think I am the coach for you?
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Your answer
Social media handle (Facebook or Instagram)
*
Your answer
NOTE: This is only an application form, so please ensure you fill out your answers as detailed as you can to give me the best understanding of you. As there are only limited spots available I want to ensure we are the right fit for you. Thanks from the B2B4LIFEFITNESS Team.
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