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Online Evaluation  
We want to know if Life Practice is right for you. Please fill out this simple evaluation form.  Take note of its simplicity – we don’t need your medical history, personal and private information.

What we do need to know is a summary of your current lifestyle habits and what your goals are.  We will email our evaluation back to you within 24 hours and we feel confident that you will have a sense of whether the Life Practice program is a good fit.

If our evaluation raises additional questions, please contact us via Live Help or send us an email.

As with all aspects of Life Practice your privacy is very important to us.  For details, read our Privacy Statement.


First Name:
Email Address:
Zip Code:
Age:
Gender:
Weight:
Describe your General Health:  





What are your health and fitness goals?  





Are you a regular exerciser?


Do you like exercise? Is it a struggle to be physically active?

 

What is your readiness to change? Are you ready to make a long-term commitment to your health?  
Tell us about your type of job or daily routine… Is it very active or do you sit behind a desk or computer?  
Please provide any additional information you feel would help your Life PracticeSM coach  

 


 




"Take control of your health, so that you may take control of your life."

-Author Unknown