Member Profile
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Email *
Name *
First and Last
Cell Phone Number *
xxx-xxx-xxxx
Today's Date *
MM
/
DD
/
YYYY
Age *
Occupation *
Height *
Weight *
Ideal Weight *
Are you currently working out? *
Do you smoke? *
At what age would you consider yourself to have been in the best shape of your life? *
How long have you been thinking about living a healthier lifestyle? *
Are you currently on any medications or supplements? Please list the medication and the reason you are taking *
What are your main reasons for hiring a trainer? *
Required
Do you have any special needs? (i.e. pregnant, joint/bone problems, high blood pressure, past/present injuries)  *
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