Physique Transformation Program Questionnaire

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Please fill in the short questionnaire below so I can gather the information I need in order to provide coaching that is a good fit for your goals and individual needs (it takes 3-5 minutes to complete)!

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[av_contact email=’mitko.k@abv.bg,mitkopkazakov@gmail.com’ title=“ button=’Submit!’ on_send=“ sent=’Your submission was successful!’ link=’manually,http://’ subject=’MLPTP questionnaire submission’ autorespond=’Your submission has been received and we will contact you shortly!’ captcha=“ form_align=’centered’ color=“]
[av_contact_field label=’Full name’ type=’text’ options=“ check=’is_empty’ width=’element_half’ multi_select=“][/av_contact_field]
[av_contact_field label=’E-Mail’ type=’text’ options=“ check=’is_email’ width=’element_half’ multi_select=“][/av_contact_field]
[av_contact_field label=’Age’ type=’text’ options=“ check=’is_number’ width=’element_half’ multi_select=“][/av_contact_field]
[av_contact_field label=’Gender’ type=’select’ options=’Male, Female’ check=’is_empty’ width=’element_half’ multi_select=“][/av_contact_field]
[av_contact_field label=’Country’ type=’text’ options=“ check=’is_empty’ width=“ multi_select=“][/av_contact_field]
[av_contact_field label=’Height (specify unit)’ type=’text’ options=“ check=’is_empty’ width=’element_third’ multi_select=“][/av_contact_field]
[av_contact_field label=’Weight (specify unit)’ type=’text’ options=“ check=’is_empty’ width=’element_third’ multi_select=“][/av_contact_field]
[av_contact_field label=’Body fat percentage (if you know)’ type=’text’ options=“ check=“ width=’element_third’ multi_select=“][/av_contact_field]
[av_contact_field label=’How did you find out about the ModelFit Lifestyle Physique Transformation Program?’ type=’textarea’ options=“ check=’is_empty’ width=“ multi_select=“][/av_contact_field]
[av_contact_field label=’Briefly describe your specific fitness goals (within the next 6 months)’ type=’textarea’ options=“ check=’is_empty’ width=“ multi_select=“][/av_contact_field]
[av_contact_field label=’Do you have any specific nutritional restrictions?’ type=’textarea’ options=“ check=’is_empty’ width=“ multi_select=“][/av_contact_field]
[av_contact_field label=’Any health problems, current or past injuries?’ type=’textarea’ options=“ check=’is_empty’ width=“ multi_select=“][/av_contact_field]
[av_contact_field label=’Do you have any experience with lifting weights?’ type=’select’ options=’I don’t have any experience with lifting weights, 1 to 3 months, 3 to 6 months, 6 to 12 months, 1 to 3 years, 3 to 5 years, 5+ years’ check=’is_empty’ width=“ multi_select=“][/av_contact_field]
[av_contact_field label=’Disclaimer: Please recognize that it is your responsibility to work directly with your health care provider before, during, and after seeking nutrition and / or fitness consultation. Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision.’ type=’checkbox’ options=“ check=’is_empty’ width=“ multi_select=“][/av_contact_field]
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