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Your Name
Full Name:
Your Email
Email Address:
Please enter a valid email address.
What is your goal?
Goals:
What equipment do you have access to?
Adjustable Dumbbells
1 or 2 Pairs of Dumbbells
Barbell
Bench
Squat Rack
Cable Machine
Kettlebell
Plates
Resistance Bands
Medicine Ball
General Machines
Trap Bar
Other
Equipment:
What is your experience level?
Beginner
Intermediate
Advanced
How often are you looking to train?
2-3 times/week
4-5 times/week
6-7 times/week
Other
Extra Details:
What's your target workout duration?
10-15 minutes
20-30 minutes
45-50 minutes
1 hour
Other
Duration:
Do you have any injuries or physical limitations?
Injuries / Limitations:
How much time do you have to cook?
15-30 minutes/day
30-45 minutes/day
45-60 minutes/day
60+ minutes/day
Other (Respond Below)
Other:
How many meals a day do you prefer?
2-3 meals
3-4 meals
4-5 meals
No preference
Do you meal prep?
Yes
No, but I'm open to it
No, I prefer not to
Dietary Restrictions?
Restrictions:
How many calories do you eat on average per day?
Calories:
Enter extra info
Macros/Day:
How can I help the most?
Single 30 minute consultation. ($30)
Workout + nutrition plans (via spreadsheets). ($80/month)
Workout + nutrition plans + form feedback on videos I send. ($100/month)
Workout + nutrition plans + two 30 minute consultations per month. ($105/month)
Workout + nutrition plans + form feedback + two 30 minute consultations per month. ($120/month)
Other
Specific Plan:
Anything else I should know?
Extra Notes:
I understand that Anika Kurup is not a licensed physician, certified personal trainer, or registered dietitian. I assume all risk for my participation and release Anika Kurup from any liability for injury or adverse health effects. I will consult a physician before beginning any nutrition or weight training program.
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