Free Health Assessment

1

Name* This field is required.What you like to be called :)

First Name

Last Name

2

E-mail* This field is required.

3

In What Country Are you Located?* This field is required.

USA

Canada

UK

Other

4

Where do you live?(i.e City, State)

5

What is your instagram handle?i.e @the_balanced_life_mama

6

Phone NumberI promise I won't spam you, this is just the easiest form of communication :)

7

Do you have a coach currently? (Please note this is not for those currently working with a coach or a coach yourself)* This field is required.

No

I had a coach a long time ago, but not currently working with one

Yes, I'm working with a coach

Robin, you are my coach! :)

8

How did you find me?

Instagram

Facebook

Website

9

If you knew failure wasn't an option, where would you like to be in 3 months (physically, mentally, emotionally, life goals)

10

What are your current health, wellness, and/or fitness struggles?

11

What is your current fitness level?

Beginner (Haven't worked out in awhile)

Intermediate ( I work out a few times a week)

Advanced ( I work out consistently)

12

Are you currently Expecting, Postpartum, or Planning to get pregnant in the next year?I often work with prenatal & postpartum moms and strive to customize my plans to whatever season you are in.

Currently Expecting

Recently Postpartum

Planning to be Pregnant

NONE OF THE ABOVE

13

Have you used BOD (BeachBody on Demand) or do you currently have BOD?

14

Which nutrition approach do you feel like you would benefit most from?

Structure - You'd be told exactly how many portions of each food group to eat based on your goals.

Flexible - You could make it work even while traveling or eating at restaurants focusing on balance.

I'm not sure

16

Are you interested in a natural plant based pre-workout/energy booster?Personally, I think it's better than coffee :)

Yes - Lemon

Yes - Mixed Berry

Yes - Fruit Punch

Maybe

Not right now