Bella Diva New Client Form Welcome Bella Diva! Let’s get started on the new YOU! Today's Date Date Format: MM slash DD slash YYYY Name* First Last Date of Birth* MM DD YYYY AgePhone*Email* Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Let's Be FriendsYour Facebook PageYour Instagram PageYour Twitter ProfileYour LinkedIn ProfileA Little More About You!What does a normal day look like for you?Any current and/or past injuries?Do any ailments or injuries still affect you?Any health conditions that affect your fitness regimen?What are you currently doing for fitness? Be honest!OK…..Time to be REAL Diva!What keeps stopping you from living a forever healthy lifestyle?What is your favorite way to move your body?What are your favorite healthy foods?What are your favorite "cheat" foods?Do you have a support system of like-minded women in your life?YesNoComments or QuestionsBella Diva Cancellation Policy I value your business and ask that you respect my business scheduling policy. Please notify me at least 24 hours in advance of any cancellations. I respect and understand emergencies happen. Any cancellations with less than 24 house of notice are subject to a cancellation fee amounting to the cost of the scheduled service. Please initial below that you read and understand. Thank you!! Initial to Agree to the Cancellation Policy*PhoneThis field is for validation purposes and should be left unchanged.