Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Instagram Handle
*
Best form of contact
*
Please Select
Email
Instagram
Phone
What is you main goal?
*
Fat Loss/Weight Loss
Build Muscle
Create Healthy & Sustainable Habits
Stop Binge & Emotional Overeating
Have a Healthy Relationship with Food & My Body
Improve Mindset with Weightloss
What has been holding you back from achieving your goals?
*
Why is changing this important to you now?
*
Where would you like to see yourself 12 months from now?
*
Have you ever worked 1 on 1 with a coach before? If yes, what was your experience like? What would you have changed?
*
Why do you want to work with me? Be honest!
*
I require a 3 month (12 weeks) commitment. Are you cool with that?
*
Yes!! That's what I am here for.
No. If you chose no, please do not continue to fill out the application.
What does success look like for you?
*
What makes you a good candidate for this program?
*
When it comes to investing in a PROVEN method for your weight loss and working with Master Coach Erin Avery, where are you at??
*
Please Select
I am ready to invest & have the financial resources
I am determined to get creative and find financial resources
I ready to invest but might need payment options
Let's Do This!!
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