LAST STEP!! Please Complete This Application
If we don't get an application from you, your booking WILL BE CANCELED. Please be honest. This application is for personal coaching clients. We teach normal people how to eat and workout however they desire WITHOUT sacrificing results. This way, you will never need another program again. No one falls off the habits they enjoy doing.
Name
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First Name
Last Name
Phone Number
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Email
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example@example.com
Which Program Are You Applying For?
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HERS 7 DAY
HERS 14 DAY
HERS 30 DAY
Other
If you selected "Other" please specify?
What is your current occupation?
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What Is Your Goal? Please be specific. (E.g. lose 20lbs, Tone up, Drop Body Fat, Improve health etc)
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What have you tried in the past? (Select those which apply)
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Gym Membership
Personal Trainer
Shakes/Supplements/Pills Etc
At home Diets/Workout Plans
Other
What stopped you from achieving your goal AND/OR sustaining it?
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What would need to happen in one year for you to look back and think "This was the best decision I've ever made, I'm so grateful I did this."?
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On a 1 to 10 scale, how dissatisfied are you with your current state? 1=Comfortable 10=Will Do Whatever It Takes To Change.
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1
2
3
4
5
6
7
8
9
10
1 is , 10 is
Is your spouse supportive of your health goals?
We work off a waiting list primarily. If selected, why will you be a good client to work with?
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Are you willing to invest financially to reach your goals?
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If Accepted, How soon are you willing to get started? NOTE: If you're not ready to start please wait and schedule when you are.
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Please Type the word "YES" if you agree with the above statement
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Please Type "Yes" To The Following Statements If You Agree
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Appointment
Submit
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