Rebuilding Body Application Form

1

Name

First Name

Last Name

2

Email

example@example.com

3

Do you have chronic muscle or joint pain? This might be in your hip, shoulder, back, neck, etc, or a combination of places.

YESNO

4

Is your average pain level at a 5/10 or less? (10/10 pain is the worst pain you've ever experienced and require medical attention).

YESNO

5

Do you live with chronic stress and/or have symptoms of it? This might be adrenal or hormonal dysregulation, poor sleep, a "wired and tired" feeling, or low energy, to name a few.

YESNO

6

On a scale 1-10, how committed are you to relieve your symptoms and build a strong, healthy, and fit body that feels good to live in?0 is no commitment, 10 is max commitment.

7

Have you invested in a coach, trainer, therapist or other professional(s) in the past to work on this problem?

YESNO

8

Are you able and willing to spend 2-3 hours per week to get great results?

YESNO

9

Are you cleared for exercise by your doctor(s)?

YESNO

10

How capable are you to invest into solving this problem right now?

If you have the solution to my problem, I'm able to invest.

I don't have any available funds right now to invest.