All-Access VIP Coaching Application

1

What is your name?* This field is required.

First Name

Last Name

2

What is your email address?* This field is required.

example@example.com

3

Where are you located (city, state, country)?* This field is required.

4

What is your phone number?* This field is required.

Please enter a valid phone number.

5

Do you want to retain all of your functionality as you continue to age?* This field is required.

YESNO

6

Are you committed to making time for your health at least 5 minutes a day?* This field is required.

YESNO

7

What is your desired 6-month health & fitness goal?* This field is required.

8

How long have you been trying to reach this goal(s)?* This field is required.

9

What are some of the challenges you face in getting to where you want to be?* This field is required.

10

Why do you feel you haven't solved this challenge on your own?* This field is required.

11

What is your support system like at home for your health & fitness journey?* This field is required.

12

On a scale of 1 to 5, how much support would you want from your coach (i.e. how much access do you want to your coach) so you can successfully reach your goals?* This field is required.

1 = I don't need a lot of communication with my coach. I'm a self-starter, and I'm fine being coached in a group setting. I just want to be told what to do and will do it on my own.

3 = I'm totally cool with talking to my coach periodically via the provided platforms.

5 = I want unlimited access to my coach and to have them in my back pocket. At this stage in my life, I need a lot of hand-holding.

13

On a scale of 1 to 10, how committed are you to reaching these goals and creating your new healthy lifestyle?* This field is required.

1 = I'm not committed

4 = I'm one foot in, one foot out and will probably keep doing the same as today

8 = I'm mostly committed

10 = I'll do whatever it takes to make this happen. I'll invest time, money & resources to make myself a priority and to turn my life around!

14

If you answered anything less than 10, what would have to shift for you to make yourself a priority and choose 10 out of 10?

15

If you answered 10, what's one thing you can do TODAY to get momentum rolling in this direction?

16

Do you currently have a consistent income from one or more sources, or have the willingness and financial stability to invest in yourself at the four-figure level?* This field is required.

YESNO

17

How did you hear about Renov8 Fitness?