Name
*
First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Gender
*
Email
*
Phone
(###)
###
####
How would you rate your curent level of fitness?
*
What are your primary health & wellness goals?
*
Check All That Apply
Do you currently have any medical condition or injury that would impact your ability to stick to the program consistently?
*
What motivates you to improve your health and wellness?
*
Have you ever worked with a coach, trainer, or nutritionist before?
*
What obstacles have prevented you from reaching your health goals in the past?
*
How would you describe your daily lifestyle?
*
Do you have access to a gym or fitness equipment at home?
*
On average, how many hours of sleep do you get each night?
*
How many meals per week do you eat out?
*
Do you drink alcohol?
*
Do you use tobacco products, including vapes and e-cig?
*
Do you currently use drugs; either prescribed or recreationally?
*
What is your annual household income?
*
Less than $30,000
$30,000 - $75,000
$75,000 - $100,000
More than $100,000
Are you willing to invest financially into your health and wellness journey?
*
This is an exclusive, invitation only program. What makes you feel like you would be a good fit for Rhythm Restorative?
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Realistically, how many hours per week are you able to dedicate to this program?
*
Are you comfortable being part of a supportive community with check-ins and accountability?
*
Given your current lifestyle, would you be interested in a flexible nutrition program that is simple, convenient, affordable, and delivers clean whole food nourishment?
*
