FEED YOUR POWER Application

Please Complete This Form

Look at you taking action and setting up a free initial consultation! Just filling this out is a HUGE win to get you closer to how you want to feel and the impact you want to make with this one and precious life. Can't wait to be in touch :)
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Your Facebook Profile link (or your full Facebook name):*
Your Instagram Handle:*

How did you find me?*

YouTube VideoPodcastInstagramReferralIn Person EventOther
Occupation*
Age, Height & Weight*
Do you feel like you need help?*

YesNoNot sure

What is your goal? What would you like to accomplish through working together?*
What would be the most important criteria for your success as we work together?*
What have you tried in the past and why hasn't it worked for you? What's stopping you from hitting your goal?*

On a scale of 1-10... 1 being I'm satisfied where I am and 10 being I'll do anything to reach my goal. What number are you?*
Does your spouse, significant other, or care taker support you? (Meaning they will give you a thumbs up on whatever you decide)*

YesNoNot applicable

What would you expect from me as your coach if we decide to work together?*
Space is limited and I want to make sure this is a good fit. Why do you think that we would be a good fit working together? Why do you want to be a part of the plant based FEED YOUR POWER community?*

My programs are holistic and provide long term behavior change, and lasting results.

After the program you should not need another coach or program again because I'll teach you every last trick in the book pertaining to plant based nutrition and fitness for long term health and to reach your goals.
Are you willing to invest financially to reach your goals? (Be ready to move forward on the call if we decide that you are a good fit for the program. IF you are not a good fit I will let you know and I will refer you to someone else) *
If accepted how soon are you looking to get started? (If you aren't excited about starting right away, please wait to schedule when you are ready. I expect those who feel it's a good fit after our next call to move forward with the program. Those who don't take action are a lot more likely to continue to spin their wheels, and never make changes to see the results they really want).*

I realize I am booking a real time slot with you*

YesNo
I will be available to take the call in a quiet, distraction free environment at our agreed upon time.*

YesNo

Thank you so much for filling out this application! I acknowledge you for having the courage to reach out, and for taking action towards not just a healthier and happier life, but also a more positive impact on the world.

Looking forward to reviewing you application, I will send you an email soon!
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Please Complete This Form