Form
Apply Here
Name
*
First Name
Last Name
What is your email
*
example@example.com
What is your phone #
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your goal? Lose weight, tone up, build muscle, a little of both?
What is your IG username/ Facebook
What is your height?
What is your approximate weight?
What is your activity level? Lightly active/Moderate/Very active
How old are you?
What do you do for a living? Married? Have Children? If so, how many?
How long would you like or need to work with us for? Are you ready to commit?
3 Months
6 Months
12 Months
What bad habits got you here?
Procrastination
Laziness
Overeating/Under eating
Emotional Stress eating
Other
Why Now? What made you decide now was the time?
I am committed to helping you achieve the best version of yourself in your mindset, body, and lifestyle. I am a firm believer in delivering value at the highest level to each and every client. Do you think you have what it takes to become your most elevated self in 2026?
How much would you be willing or able to invest in yourself? This helps us to see which coaching programs you would be most qualified for.
$228 monthly
$350 monthly
$500 monthly
$160-$185 monthly would be our lower accountability-lower level coaching programs
I do not qualify at this time-keep me on your email list for special deals that we roll out on special occasions.
How soon could you get started if you see we are a good fit on the call?
Now
within the week
Later
If we work together, what will you expect from the coaching? Be completely honest.
Do you have the ultimate decision-making powers for yourself, or do you need someone else's permission?
READ ME-I will be giving you a valuable gift for taking the time to fill this info out and for showing up for our breakthrough call we are going to have. You will be sent a text to get on my schedule for a 30-minute coaching call with me. I will be putting my coaches hat on and going really deep into helping you fix some of the problems you have been having. Looking forward to meeting with you!
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