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Full Name  *Date of Birth  *Gender  *Phone Number  *Email  *In general, what are your fitness goals? Check all that apply. 

Out of all of the above items, which ones are most important to you? Why?  *What would you hope to accomplish by working with GMC's fitness and wellness specialist?  *Is there anything else you feel you need to share with our fitness specialist to prepare for your consult? 
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