Privacy and Consent *

By completing this form, you acknowledge and consent to PirtFit Nutrition Coaching collecting and using your information to provide personalized nutrition services. All responses are kept confidential and will never be shared without your written permission. Your information is securely stored and used solely for assessment, coaching, and communication purposes related to your health and wellness goals. If you have any concerns, feel free to contact me directly at pirtfit@gmail.com.

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Name *

First Name

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On a scale of 1-10 (10 being EXTREMELY), how ready are you to change your lifestyle? *

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10