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FWW Fitness & Wellness Questionnaire
First name
*
Last name
*
Email
*
Phone
Do you follow a current exercise regime? If yes, please explain.
*
Are there any physical limitations that would inhibit or limit your participation in an exercise program?
Do you take any vitamins, minerals, or supplements? If yes, please list below:
*
Do you take any medications, please list below & reasons for taking:
*
Thank you for your interest in starting a fitness program. We'll get back to you shortly.
Submit
Fitness Questionnaire
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