To confirm, you are filling out this application to learn more about weight loss and exercise coaching in order to improve your physical fitness, health and/or appearance. Is that correct?
Yes, I am serious about improving my health and physical fitness.
No, I will leave this page immediately
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Which of the following best describes your diet and exercise goals?
I want to lose weight and body fat
I want to tone and build muscle
I want to improve overall appearance
I want to stop bingeing
I want to stop yo-yo dieting
I want to feel confident and happy
Other
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What does your ideal body look like?
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How will you feel when you achieve your physical goals?
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The best coaching/mentoring program is tailored to each individual's lifestyle. What is your occupation and do you work full time?
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Be 100% honest, what do you think is stopping you from having your ideal body?
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Do you have a significant other that would need to be on the call?
No
Yes, I will make sure to book a time when we are both available
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If you feel the diet, exercise and mental shift we map out for you will be a good fit are you willing to make a monetary investment to reach your goals?
Yes, I have the cash needed to invest in my health.
Yes, I may or may not have the cash on hand but I can get resourceful and/or have access to credit.
No, my cash flow is month to month and I have no access to credit.
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Name
First Name
Last Name
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Email
example@example.com
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Phone Number
Please enter a valid phone number.
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Last question, on the next page you will be able to book your free consultation call with me. Will you 100% be able to make the time you choose? I do not reschedule for no-shows.
Yes, I will stay 100% committed to the time I choose
Maybe, I am not sure if I am serious
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