First Name
*
Last Name
*
Email
*
Phone
*
Fikaa Glen Eden - 273c West Coast Road, Glen Eden
Cell - 021-1993649 EM - gleneden@fikaa.nz
What gender do you identify as
What gender do you identify as
Male
Female
Non-binary
Prefer not to say
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What's your age range?
What's your age range?
15-20 years old
20-30 years old
30-40 years old
40-50 years old
50-60 years old
60-70 years old
70 + years old
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commitment
100% committed to improving my lifestyle!
Seriously committed!
Meh...not at all.
fitness level
I'm extremely fit!
I'm fit.
I'm a bit out of shape.
I am REALLY out of shape.
Fikaa Glen Eden - 273c West Coast Road, Glen Eden
Cell - 021-1993649 EM - gleneden@fikaa.nz
What food do you not enjoy eating?
Is there anything else we need to know? Dietary requirements etc
What would make it easier for you to stick with your plan?
Please provide any further information that will help us in designing your plan
Fikaa Glen Eden - 273c West Coast Road, Glen Eden
Cell - 021-1993649 EM - gleneden@fikaa.nz