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10
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1
When it comes to achieving your health, fitness and transition goals, what’s the
single biggest challenge, frustration or problem
that you’ve been struggling with?
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Please be as detailed and specific as possible.
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2
Which best describes your current level of physical activity?
The reason for asking is because knowing your level of fitness will help us better serve you.
Very Low - I never do any kind of exercise. I lead a very sedentary lifestyle.
Low - I exercise or engage in physical activity on occasion, but nothing very intense.
Average - I sometimes exercise or engage in physical activity.
High - I exercise and/or engage in physical activity at least three times per week.
Very High - I train/exercise almost daily at a medium-to-high intensity.
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3
Which of the following best describes your age?
The reason for asking is because knowing your age will help us better serve you.
Under 20 years old
20's
30's
40's
50's
60 years old or above
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4
If we were to create a paid program on one of the following topics (and you had to choose just one), which of the following are you most likely to have signed up for if it was already available?
Bulk Up and Gain Muscle - Wanna get bigger? This is a self-paced high intensity training program to help you build muscle mass.
Build Lean Muscle - Strength Matters. This is a self-paced training program that is less about getting big, and more about building lean muscle for strength.
Stretching to De-stress - A low intensity movement program with a main focus on mobility and gentle exercises to leave you feeling refreshed and feeling better.
Weight Loss - A training program to help you trim down and lose weight.
Stand Up, Tone Up - An incremental low-to-medium intensity program to help you get off the couch and moving more regularly to get more toned. It includes additional nutritional advice and tips.
Top Surgery Preparation and Recovery - A program designed to prepare folks for top surgery and to get moving again post recovery.
Other
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5
How did you find out about us?
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6
Last Step:
What’s your best contact information so I can get you started on the 14 Day Free Trial and make sure you’re notified about the new program when it’s made available?
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What's your first name?
First Name
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7
What's your last name?
Last Name
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8
What are your pronouns?
Pronouns
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9
What's your email address?
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This field is required.
example@example.com
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10
Phone (Optional)
Lastly, I may wish to follow up with a few people on the phone personally to better understand your situation. Would you be open to speaking on the phone for a few minutes on the condition that I promise not to sell you anything? If so, would you please leave your phone number below? Thank you!
Area Code
Phone Number
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