Application

1
Are you ready to start feeling more confident in your own body?Answer the question
YESNO
2
What describes your situation?Choose select all that apply
I want to feel confident and healthy in my own skin.
I want to stop yoyo dieting and get my nutrition under control.
I want to heal my relationship with food and not let it control me and my emotions.
I want to learn how to eat and exercise intuitively.
I want to become stronger physically and mentally.
I want to move my body and have more energy.
I want to take control of my health and my life.
I am tired of believing the mean things I say about myself.
Other
3
What body type are you?Choose the best answer
I am small and sassy
I am not too big but not too small with a soft middle ground
I am fluffy in all the right places (50lbs or less to lose)
I am a hefty hunny (50lbs or more to lose)
I prefer not to answer
4
What types of diets have you tried?Choose all that apply
Weight Watchers
Atkins
Paleo
Keto
Fasting
No carb/ Low carb
Gluten Free
Vegan/ Vegitarian
Juice Cleanse
Macronutrients
None of the Above
Other
5
How aware are you of your eating habits?Choose the best answer
I know I don't eat well at all
I am somewhat aware of my eating habits
I know what triggers my binge eating but I don't have the right tools to get it under control
I am pretty confident in my current nutrition
Other
6
How often do you exercise?Choose the best answer
Me exercise?
I go every once in a while
Maybe once a week
Multiple times a week
7
Where do you exercise?Multiple Choice
I'm a home body
I have a home gym in my basement
I have a gym membership
Outside or my backyard
I currently don't workout anywhere
Other
8
What type of training to you usually do?Choose all that apply
No training yet
Weight Lifting
Group training classes ( ie Zumba)
Cross fit
Cardio (ie walking, running, biking)
Functional Training
Yoga
I PlaySports
Other
9
Rate your confidence level nowslide to answer
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4
10
Where do you see yourself in 6-12 months?
I want to feel happy, healthy and cofident
I want to be in control of my body and eating habits
I want to drop 10-15 lbs of body fat
I want to 20+ lbs of body fat
I want to add lean muscle
I want to feel confident and comfortable in my own skin
I want to feel comfortable making exercise and food choices without coach's help
I want to have better mental strength to overcome cravings and bad habits
11
What is holding you back from achieving these goals?
I have a hard time sticking to a diet- I have a hard time believing it will work
I just can't get past the cravings.
I can stick to a diet- when it stops working I usually give up
I have no problem putting in the work- I just don't know what to do.
I want to put in the work I just have some resistance.
I don't have the right knowledge. This is causing inaction and I am done.
I have a hard time committing and I need a huge element of support.
I dont have the right people around me that think like me and can support me
I don't have expert coaches or advice that will help me get back on track.
12
Please share any other pitfalls that are holding you back from your health and fitness goals?
Huge
Large
Normal
Small
Ok
Ok
13
Please explain other goals that you want to achieve? Why do you need Holly's help?
Huge
Large
Normal
Small
Ok
Ok
14
Are you prepared to take action and invest a considerable amount of time, funds, and energy in yourself to reach your goals if you were certain that you would get them?
YESNO
15
How committed are you to solving this problem today?
5/10- I don't want to improve my situation that much and I am OK with not making more progress then I am right now.
7/10- I am pretty frustrated with things right now and want to get them sorted out, the sooner the better.
9/10- This is effecting my confidence, energy, and how I am showing up in life. I want to get this sorted out ASAP!
10/10-I will literally do anything right now to get this situated. I don't want to go one day longer without a sustainable, healthy program that will give me long lasting results improve my body composition and make me feel better.
16
If you are accepted into the program how soon can you start?
17
Where did you hear about us?* This field is required.
18
Name* This field is required.
First Name
Last Name
19
Email* This field is required.
example@example.com
20
Phone Number* This field is required.
Please enter a valid phone number.
21
Age?* This field is required.
Should be Empty: