Intake form - Physique Connoisseur

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Intake form

This is the beginning of your complete transformation. Please complete this form as honestly as possible. You got this 💪

- Step 1 of 6

Name *

First

Last

Date of Birth *

Weight *

Height *

Lightest weight in the past year *

Weight at 21 years old *

Weight at 16 years old *

How many times a day do you eat? *

What time do you go to sleep? *

What time do you wake up? *

How often do you workout/ exercise per week? *

What kind of work do you do? *

How many hours do you spend working? *

Do you have any physical injuries or dispositions? *

Do you have any specific dietary restrictions? *

What are your physical and mental goals ? *

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Work with me
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