Empower Physique Coaching Application

This is an opportunity to apply for my ELITE 1-on-1 Coaching Program. Our coaching has helped 2000+ people unlock their full potential mentally and physically for life!

We are a firm believers in over-delivering value to each and every client. For that reason, I have a strict client cap for 1-on-1 coaching; I cannot promise you availability if you wait to take action on this opportunity. *If approved, I'll be in touch within 24hrs and I'll send you a personalized video!
Whats your full name? *

First NameLast Name
What's your age, height, and weight?*
What's the best number to reach you at?*
Please enter a valid phone number.
What's your email? *
example@example.com
What's your instagram handle?*
What is your Facebook name?*
Do you have any kids? If so, how many?
How many days do you CURRENTLY exercise weekly? BE HONEST. *
How many days a week can you realistically dedicate to exercising? *
What is your number one goal right now? Specifically, how do you want to feel/look?*
Please be as detailed as possible.
How long have you been stuck on this journey for? How does it affect you on a day to day?*
What is holding you back from reaching your goal? What is your true motivation to start now?*
Do you currently follow any specific diet + How would you describe your current relationship with food? (keto, Atkins, low fat, vegetarian, vegan, etc)*
Please attach a front photo of your current physique.

Men - in swim trunks. Women - in bathing suit, or sports bra and shorts.
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Please attach a back photo of your current physique.

Men - in swim trunks. Women - in bathing suit, or sports bra and shorts.
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Do you have any experience with tracking macros?*
Are you looking to train in the gym or at home? If training at home, what equipment do you have?*
How many steps do you take a day on average? *
How often do you eat out per week? Please provide some of your go-to examples. *
Do you have a preference of coach you would like to work with?*

Coach EllieCoach RichCoach CandaceIndifferent
What do you do for work? How active is your job (sitting, standing, walking and/or physical labor)?*
Why now? Why not 3 months, 6 months, or even a year from now? Why do you want to make these changes to your health and lifestyle NOW? *Please be in depth here.**
Why do you want to work with US, and be a part of the EMPOWER PHYSIQUE FITNESS ACADEMY?*
How committed are you to reaching your goals and making a transformation? On a scale from 1-10? *
We are going to teach you the RIGHT way to do this. Our focus is to help you surpass your goals, but actually know how to maintain it. Are you willing to invest your time and energy into this program, and trust us to deliver the results you want?*
What best describes your intention for submitting this application?This question is required.*
What best describes your intention for submitting this application?*

I am 100% committed and ready to start today!I'm not serious just inquiring (if this is the case please wait until you are 100% ready to fill out this form.
Did a friend refer you to us? If so, who? *
Working 1-on-1 with me as your NUTRITIONIST/SPECIALIST is NOT FREE or CHEAP. I only work with clients who are seriously committed. If approved, please select the level are you 100% able and willing to invest at to reach your health and fitness goals. (NOTE* understand the program is a 6 month minimum time frame)*

A. $800-$1000/month, world-class coaching (VIP Concierge Program)B. $600 - $800/month, high-level coachingC. $400-500/month, Industry average level coachingD. $300-400/ month I am OK to work with a head coach at empower physique and not Ellie directly.E. $0, I am not willing to and cannot commit to invest to improve my life
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This is an opportunity to apply for my ELITE 1-on-1 Coaching Program. Our coaching has helped 2000+ people unlock their full potential mentally and physically for life!