Consult Form | powerfxcoaching.com

Please fill out this short form so that we can have a chat and review where we think you are going wrong and put you in the right direction!

First Name

Last Name

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Right now, what do you feel is going wrong with your health and fitness?

What changes would you like to see over the next 3-6 months for you to be happy with the progress?

What is currently holding you back from achieving this?

On a scale of 1-10, How would you currently rate yourself?

What positive impact would it have on your life getting that previous rating to a 9 or a 10

How committed are you to change and progress?

I'm 100% committed to making a change to my health and fitness Not too bothered A little bit, have other priorities that's not my health and fitness

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