Free Month Form

Primal Qi Fitness

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1 Month Free Individualized Workout Program

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Social Media *

Briefly describe your training experience. How long you've been training for, what you typically train, why, your best lifts (i.e. deadlift 405lbs), etc. *

Choose any you want to work on *

Squat Deadlift Bench Pull Ups Push Ups Abs / Core Glutes Conditioning / Sport Specific Work Olympic Weightlfiting Competitive Athletics General Health and Fitness Lose Weight Gain Strength Build Muscle Aesthetics Body Weight Training

Specify Goals in more detail (Helps A Lot) *

How many Days per week do you work out, and what time of the day? *

Do you have any previous injuries or current pains? *

No Back Shoulder Elbow Hip Ankle Other

If other Please Specify *

What is your age? *

Less than 13 13-18 19-25 26-35 36-50 Over 50 Prefer not to say

Submit

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Home
- Memberhip Home Page >
  - Movement Library
  - Champion Series
Apparel
Personal Training & Programming
Diabetic Awareness
Blog
Free Month Form
New Page
free stuff