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Goals Assessment

Goals Assessment

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Question 1 of 21

First and Last Name

Question 2 of 21

Email

Question 3 of 21

Phone Number

Question 4 of 21

Why do you feel you need accountability?

Question 5 of 21

What is your current weight?

Question 6 of 21

Body Fat Test of BMI

A

Yes

B

No

Question 7 of 21

BF %?

Question 8 of 21

BMI?

Question 9 of 21

What is your goal weight?

Question 10 of 21

Height?

Question 11 of 21

Your Age?

Question 12 of 21

Describe your current workout routine. Please be specific.

Question 13 of 21

Share some cheats, treats, and indulgences you enjoy?

Question 14 of 21

How often would you say you enjoy these kinds of things?

Question 15 of 21

List past or current medical conditions:

Question 16 of 21

Have you experienced an eating disorder? If so, please list or describe and include the dates.

Question 17 of 21

Do you take any medications? If so, please list.

Question 18 of 21

What other programs have you tried in the past?

Question 19 of 21

Have you ever had a personality test? If so, what did it teach you?

Question 20 of 21

What is your Instagram handle/profile name?

Question 21 of 21

Have we worked together in the past?

A

Yes

B

No

Confirm and Submit