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Please answer the following questions so I can better understand your situation and your goals.
Your Email Address
What is your gender?
Male
Female
What age group are you in?
I am in my 20's
I am in my 30's
I am in my 40's
I am in my 50's
I am in my 60’s
I am in my 70’s or older
Are you a fitness trainer, physical therapist, or other health professional?
Yes
No
Which health & fitness goal is MOST IMPORTANT to you right now?
Lose Weight / Get In Shape
Get Stronger / Build Muscle
Overcoming Current Injuries
Longevity / Safe Training / Increase Energy
What pain or injury do you need help with? (choose one or more)
Neck Pain
Shoulder Pain
Elbow Pain
Wrist & Hand Pain
Back Pain
Hip Pain
Knee Pain
Foot & Ankle Pain
Do you have any health concerns? (choose one or more)
Do you have/are you concerned about Diabetes? (CHECK IF APPLIES)
Do you have/are you concerned about Alzheimer’s? (CHECK IF APPLIES)
Do you have/are you concerned about Heart Disease? (CHECK IF APPLIES)
Do you have/are you concerned about Muscle Pain? (CHECK IF APPLIES)
Do you have/are you concerned about Vision Health? (CHECK IF APPLIES)
Do you have/are you concerned about Joint Pain? (CHECK IF APPLIES)
Where do you live?
USA
Canada
Europe
Mexico
Central or South America
Australia or Surrounding Area
Asia or Africa
