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Personal Information
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Motherhood Information
Type of Birth
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Number of Children
Name of you First Child
Birth Year of your First Child
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Name of you Second Child
Birth Year of your Second Child
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Birth Year of your Third Child
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Birth Year of your Fourth Child
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Health Information
Medical Conditions
We would love to know about your medical condition. If you don’t have any medical conditions, please feel free to leave this field blank.
Injuries or Physical Limitations
Please describe your injuries or Physical Limitations below, if you don’t have any medical conditions, please feel free to leave this field blank.
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Lifestyle Information
Occupation
Daily Activity Level
Choose the option that best describes your lifestyle: Sedentary (little to no activity), Lightly Active (some daily movement), Moderately Active (regular exercise), or Very Active (frequent intense workouts).
Sedentary
Lightly Active
Moderately Active
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Access to Gym/Equipment
Assault Bike
Battle Ropes
Elliptical Trainer
Foam Roller
Massage Gun
Medicine Balls
Parallel Bars/Dip Station
Plyo Box
Pull-up Bar
Resistance Bands
Resistance Loops
Rowing Machine
Sandbags
SkiErg
Slam Balls
Stair Climber
Stationary Bike (Upright/Recumbent)
Stretching Bands
Treadmill
TRX Suspension Trainer
Yoga Mat
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Wellness Goals
Primary Wellness Goal
Weight Loss
Strength Building
Flexibility
Mobility
Stability Improvement
Better Peformance
Postpartum Recovery
General Fitness
Stress Relief
Secondary Wellness Goals
Nutrition Improvement
Mental Health
Sleep Quality
Energy Levels
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Fitness Background
Current Fitness Level
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Types of Exercise Interested In
Cardio
Strength Training
Yoga/Pilates
Group Classes
Home Workouts
Outdoor Activities
Previous Exercise Experience
Please state "None" if you do not have any previous exercise experience. If your answer is "Yes," please describe below:
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