Client Registration - Lighthouse Wellness Coach

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New Client Registration Form

Please complete this form to register as a new client. This information will help us provide you with the best possible service.

Fields marked with an asterisk (*) are required.

Personal Information

First Name

Last Name

Phone Number

Home Address

City

State

Zip Code

Goals & Package Information

What is your primary fitness goal?

What event are you preparing for?

When is your event?

Which of our packages are you interested in?

When would you like to start?

Any additional information you'd like to share:

Referral Information

How did you hear about us?

Website/Online Search

Social Media

Referred by a Friend/Family

Event or Workshop

Other

Privacy Notice: The information you provide will be used solely for the purpose of creating your client profile and providing you with our services. We will never share your personal information with third parties.

Lighthouse Wellness Coach

New Client Registration Form

Personal Information

Goals & Package Information

Referral Information

Thank you for registering!