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Fire'n'Ice Fitness
Never ever give up!

Fire'n'Ice Fitness
Brenda Lucas
5 River Links Blvd.
Hope Island, QLD 4212

Mobile: 0404 873 661
Email: training@firenicefitness.com.au

To find the best solution for you we ask you to fill out the following form. We will then contact you within 2 days.


Your personal details:

First & last name

 



 

Address

 

Suburb

 

Postcode

 

State

 

Email

 

Contact number

 

Best time to contact

 

Afternoon

Preferred medium

 

Phone


Your Fitness Profile

 

 

Goals










What do you wish to improve?









Questionnaire

 

1) HOW IMPORTANT is it for you to achieve these goals?
(scale of 1-10, 1 being the most important)

2) How would you rate your current EATING HABITS?
(scale of 1-10, 1 being the very healthy)

3) How would you rate your current ENERGY LEVELS?
(scale of 1-10, 1 having a lot of)

4) How would you rate your current SLEEP QUALITY?
(scale of 1-10, 1 being good quality)

5) How would you rate your SELF ESTEEM?
(scale of 1-10, 1 having a lot of)

Interested in:

Comments:

 

 

 


 


 

 

 

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