LI & LI Application Form

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LI & LI Application Form

LI & LI Application Form

This is an opportunity to apply to work with me directly inside of the Lose It & Leave It weight loss coaching program. Let's put an end to your weight struggle by never dieting again.

15Questions

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
On a scale of 1 - 5, how committed are you to making changes to achieve your health and weight loss goal?
Not committed at all
All in commitment
4
Are you determined to permanently lose weight?
YESNO
5
How much weight do you want to lose (in pounds)?
6
What’s your current weight and goal weight?
7
What are your biggest struggles in terms of reaching your goal?
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Ok
Ok
8
What do you think has prevented you from overcoming this so far?
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Ok
Ok
9
Why are you especially committed to overcoming them now?
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Ok
Ok
10
If you are still struggling with the same challenges one year from now, how will you feel?
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Ok
Ok
11
How will you feel about yourself 6 months from now if you truly commit to yourself and achieve this goal?
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Ok
Ok
12
Why is it important for you to lose this weight?
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Ok
Ok
13
On a scale 1 - 5 (1 being not important, 5 being EXTREMELY IMPORTANT & READY TO TAKE ACTION NOW), how important is it for you to overcome your weight loss obstacles to end your weight struggle and achieve your goal?
14
Are you willing and ready to make a financial and time commitment to solving these challenges to finally attain the results you want? If so, why? If not, why not?
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Ok
15
Why do you think I am the right person to help you make these changes?
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Ok
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