21 Days of Free Health Coaching

Are you finally ready to lose weight, feel better and be done with dieting for good? Just spend a few minutes helping us get to know you better, and you may qualify for 21 days of free health coaching to address your specific issues. Let’s start getting you on the right track!

Experience Movement Self-Assessment Survey

Name(Required)

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Email(Required)

Gender

Male

Female

Age

Birthday

Height

Weight

What medications/supplements (if any) are you taking?

What is your current stress level (scale of 1-10)?

What have you tried in the past to lose weight or change your fitness?

What are your favorite foods? Be as specific as possible, please.

What are foods you will not eat?

What does a typical day of eating look like for you?

How long have you been physically active? What does your current activity/routine look like?

Do you have any injuries I need to know about that currently impact your fitness and health?

What does your daily schedule look like (work/etc)?

How much time are you willing to commit to a workout program?

What do you feel like you really need for success in losing weight and/or changing your body?

What's your favorite way to workout?

Tell me about your goals, please. The more detail the better.

Anything else I should know about you or that you think might help?

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Experience Movement Self-Assessment Survey

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