Full Name
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Email
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Phone Number
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What do you do for a living? Tell me about yourself and your lifestyle.
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Are you dealing with Chronic Muscle and/or Joint Pain?
Yes
No
What is your current workout and nutrition routine?
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What is the #1 goal you want to achieve over the next 6 months?
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What's the main barrier holding you back from reaching this goal?
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How soon are you looking to get started?
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Immediately
Within 1-2 Weeks
A Month or Longer
Are you in a place where you are able to invest financially health and wellness over the next 3-6 months?
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Yes
No