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Her Smile's Expression Of Interest Form
IF YOU HAVE TRIED EVERYTHING AND NOT GOT THE RESULTS YOU HAD HOPED FOR and are ready for change, please go through this form and answer the questions.
That way we can understand how we can help you better.
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* Indicates required question
Email
*
Your email
Full Name:
*
Your answer
Mobile Number
*
Your answer
Which one of the following best describes your situation
I lead a sedentary lifestyle
I have had one or both hips replaced
I have had one or both knees replaced
I am waiting for knee or hip replacement surgery
I am struggling with incontinence
I suffer with back pain
I am a diabetic
I have a waistline of over 80cm
I am physically active but not getting the results I would like
Clear selection
Which Her Smile Exercise Programs are you interested in?
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Her Smile 'Spring in Your Step' Ten Day Challenge
Her Smile's 'Let's Move Correctly' 12 week Online Program
Personal Training Online
Personal Training Face to Face
I would like to discuss other options
Which is the best way for us to communicate with you?
*
Please text me on the above mobile number.
Please phone me on the above mobile number
Please email me on the above email address
I would like a no obligation discovery call with Adele please
Thank you very much we will be in touch with you shortly, Adele and Kirsten
Send me a copy of my responses.
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