Health & Fitness Program Questionnaire

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We are very EXCITED to see if this health and fitness program is a good fit for you. Please BE HONEST with your answers.
Name *

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

Area Code Phone Number

What is your goal? Lose 20 lbs? Gain 20 lbs of muscle? Overcome depression? Be specific. Doesn't just have to be a physical goal. *
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 or significant other support you? (Meaning they will give you a thumbs up on whatever you decide) *

Yes No Not applicable

What would you expect from me as your coach if we decide to work together? *
Space is very limited and I want to make sure this is a good fit, why do you think you would benefit from a call or be a good addition to our program, if invited? *

I'm not the cheapest but I will solve your issue forever. After the program you should never need another coach or program again because you will aquire skills and knowlege to support your health for the rest of your life.
With that said, are you willing to invest financially to reach your goals, if we find a plan that fits within your budget? (Be ready to move forward on the call IF YOU and me decide you're a good fit for this program. If you are not a good fit I will let you know and refer you to someone else) *
If accepted how soon are you looking to get started? (if you aren't ready please just wait and schedule when you can. I expect those who feel this program is a good fit, to move forward. Those who don't take action are 95% more likely to continue their current lifestyle). *

I realize I will be contacted to be booked for a call. *

Yes No
I will be available to take the call in a quiet, distraction free environment at our agreed upon time. *

Yes No
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