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We offer 4 powerful programs designed to transform your lifestyle:

🥗 Nutrition Plan – Fuel your body the right way
🏋️ Workout Plan – Build strength and confidence
🔥 Toning Program – Sculpt and define your physique
👑 12 Sessions VIP Coaching – One-on-one guidance to fast-track your results

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SELECT PROGRAM: *--- Select Choice ---Nutrition PlanWorkout PlanToning Program12 Sessions VIP Coaching

SEX: *--- Select Choice ---MaleFemale

AGE: *

WEIGHT: *

HEIGHT: *

CURRENT JOB: *

REGISTRATION DATE: *

MOBILE NUMBER: *

GOAL: *

MEDICAL INFORMATION: ARE YOU TAKING ANY MEDICATIONS? ( if yes please list) *

History of heart problems? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

History of lung problems? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

History of diabetes? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

Surgery within the past 3 months? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

Advised from physician not to exercise? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

Muscle, joint or back pain that could aggravated by physical activity? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

High blood cholesterol? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

Smoker? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

Chronic illness? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

History of blood pressure? *--- Select Choice ---YESNO

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST

If you answered YES to one please explain:

PLEASE LET US KNOW IF YOU HAVE RECENTLY, OR IN THE PAST HAD ONE OF THE FOLLOWING ABOVE

Are you currently or have you been pregnant in the past 3 months? *--- Select Choice ---YESNO

If so, does your physician been notified that you are participating in a physical activity? *

1. Protein preferences : 2. Carbs preference : 3. Fruit preferences;

your of AND

PLEASE READ THE FOLLOWING PARAGRAPH CAREFULLY AND SIGN *

• I confirm the undersigned, state that all the information on my health sheet is correct
• I shall take full responsibility concerning my safety and will not hold THE FITNESS FORMULA the responsibility for any injuries I may suffer from.

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