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Please fill out the form below so we can prepare for your appointment. If we don't receive an application from you, your appointment WILL BE CANCELED. Please answer each question honestly and to the best of your ability!
Name
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Best E-mail (Please use the same one you gave for appointment booking)*
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Phone Number
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What Is Your Occupation?
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What Is Your Age & Weight?
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Please Provide the Link to Your Facebook Profile Here:
Do You Feel Like You Need Help to Achieve Your Goals?
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Yes
No
Not Sure
How Soon Do You Want To Get Started On Achieving Your Health / Fitness Goals?
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Right Away!
Next Week
Next Month
Next Year
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What exactly is your goal? Please be as specific as possible! Do you want to lose 20 pounds of fat, gain 20 pounds of muscle, get off of your medications, increase confidence, overcome depression? Your goal does not have to just be a physical goal.
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On a scale of 1 to 10 - 1 being "I'm satisfied with where I'm at," and 10 being "I'll do anything to reach my goal" - What number are you?
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Satisfied
1
2
3
4
5
6
7
8
9
I'll Do Anything
10
1 is Satisfied, 10 is I'll Do Anything
What have you tried in the past and why hasn't it worked for you? What's stopping you from hitting your goal?
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Are you willing to use a credit card, PayPal Credit, or borrow money if you feel like this program is what you need to succeed?
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Yes
No
Does your spouse or significant other support you? (Meaning will they give you a thumbs up on whatever you decide to do?)
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Yes
No
Not Applicable
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What are your expectations for me as your coach if we decide to work together?
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Space is very limited and I want to make sure this is a good fit for the both of us. Why do you think you'd benefit from a call or be a good addition to our mentorship program, if invited?
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My Programs Are About Teaching, Not Just Bossing You Around.
I'm not the cheapest option, but I will solve your problem forever. After working with me, you will never need another coach or program again because I'll teach you every trick in the book when it comes to diet and exercise. I will empower you to live a fun, healthy lifestyle and show you how you can sustain your success for years to come!
I realize that I will be booking in a real time slot with you.
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Yes
No
I will be available to take the call in a quiet, distraction-free environment at our agreed upon time.
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Yes
No
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