Full Name
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Email
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Have You Tried Coaching Before?
Yes
No
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Activity Level
Currently No Exercise
1-3 Times Per Week Of Light Exercise
4-5 Times Per Week Of Moderate/Intense Exercise
Very Intense Exercise or Physical Job
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How Often Do You Eat Out?
Rarely
1-2 Times Per Week
3-5 Times Per Week
Daily
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How Much Water Do You Drink In A Day?
Less than 24 ounces
24-40 ounces
40-56 ounces
56-72 ounces
72-88 ounces
88+ ounces
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What Is Your Alcohol Consumption?
0
1-2 drinks per month
1-2 drinks per week
Daily Consumption
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How Many Hours of Sleep Do You Average per Night?
8+
7-8
6-7
Less than 6
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How Would You Rate Your Stress Levels?
Low
Moderate
High
Very High
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