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Home: Welcome
Tell us about yourself!
Preferred Pronouns
She/ Her
He/ His
They/ Them
Ey/Em
Ze/ Ze
Ze/ Hir
Xe/ Xem
Yo/ Yon
Prefer not to say
Current Age
*
Under 18
18-29
30-39
40-49
50-59
60+
How many hours do you spend seated Each day?
*
0-5
6-10
11-15
15+
How often do you exercise per week?
*
Seldom
1-2 days
3-4 days
5-7 days
What currently frustrates you about your wellness routine (or lack thereof)
*
Couldn't be happier!
I could do better
Completely frustrated
How much sleep do you get?
*
Fewer than 5 hours
5-6 hours
7-8 hours
How well do you sleep? (Check all that apply)
No issues, sleep like a baby!
Trouble getting to sleep
Trouble staying asleep
Other (explain in comments box below)
Are you experiencing pain or injury? (If yes, provide details below)
*
Yes
No
Which services interest you? (Check all that apply)
Semi-Private Training
Individualized Plan
Personal Training
Physical Therapy
Not Sure Yet
Comments
Name
Email
Phone
I am ok with texting
Submit Answers
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