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Wellness Survey

Please fill out the following form so we can get a sense of your goals.

First name*

Last name*

Age*

Weight*

Height*

Sex*

Phone*

On a scale of 1-10, how serious are you?*

Describe your health goals, ie lose weight, improve mobility, improve muscle strength, etc*

If you have a weight loss goal, how many pounds are you trying to lose?

Do you take any vitamins or supplements?*

Yes

No

Do you have any physical health problems? If so, list them.

Are you on any medication? If so, list them.

Do you exercise? If so, how often.

What is the biggest challenge in your health journey? For example, losing weight.*

Have you tried any other weight loss program? If so, name them.

Initials*

I declare that the info I’ve provided is accurate and provided voluntarily.

4D Fitness 4Life

HOME THE CHALLENGE EXERCISE COURSES SUPPLEMENTS ABOUT CONTACT US

†Results vary depending on starting point, goals and effort. Exercise and proper diet are necessary to achieve and maintain weight loss and muscle definition. The testimonials featured may have used more than one 4D Fitness product or extended the program to achieve their maximum results.

Consult your physician and follow all safety instructions before beginning any exercise program or using any supplement, nutrition plan or meal replacement product, especially if you are pregnant, breastfeeding, or if you have any unique or special medical conditions.

The contents on our website are for informational purposes only, and are not intended to diagnose any medical condition, replace the advice of a healthcare professional, or provide any medical device, diagnosis, or treatment.

support@4DFitness4Life.com

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