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Iron Sharpens Iron



Email Address*


Are you currently taking any exercise program?*

Height *


Do you have the following conditions?*

Select an option

Other medical condition not listed.

Are you a smoker?*

If yes, how often?

Are you pregnant (Female only)?

If yes, how far along?

Do you drink alcohol?

If yes, how often?

Do you eat 3 meals a day? (Breakfast, Lunch, Dinner)*

What do you usually eat for breakfast?*

What do you usually eat for lunch?

What do you usually eat for dinner?*

Are you currently taking medications? If yes, what are the medications and for what purpose?*

Have you had any injuries in your body? If yes, please indicate the location*

Have you been previously hospitalized? If yes, please indicate when and why.*

Did you undergo any surgeries in the past? If yes, please indicate the type of surgery*

What are your goals in this program?*

Select an option

Other goals not listed.

Complete the form on the left and our intake coordinator will contact you to set up the initial consultation in 24 - 48 hours.

"Health is wealth"

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