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Gold Intake Form
First name
*
Last name
*
Email
*
Phone
Birthday
Year
Month
Day
Personal Goals
Choose one or more goals
*
Lose weight
Build muscle
Improve strength
Improve endurance
General fitness
Sports Performance
Rehabilitation
Other
What is your primary fitness goal?
Experience Level
What is your current experience level?
Beginner (0–6 months)
Intermediate
Advanced
Health Screening
Do you have any medical conditions or injuries we should know about?
*
No
Yes (please describe in next field)
If you answered yes to the previous question please explain further
Are you currently under the care of a physician for exercise-related concerns?
*
Yes
No
Do you have any of the following?
*
Heart condition
High blood pressure
Diabetes
Joint/back pain
Pregnancy
None of the above
Training Preferences
How would you like to train at Tier1 Boxing and Fitness
*
Personal training
Group classes
Strength training
Cardio
Functional fitness
Nutrition coaching
Additional Information
Is there anything else you'd like your trainer to know?
Consent
Consent section
*
I confirm the information I've provided is accurate.
I agree to be contacted regarding my inquiry.
I would like to receive promotional emails.
Submit
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