Blueprint Application

1
Are you interested in getting in control of your body and the way it looks?* This field is required.This is what we do so I just want to make sure :)
YESNO
2
What body type are you coming to us with?* This field is required.Please select all that apply.
Skinny - need to add some tone
Skinny fat - I am in a soft fluffy middle ground
Medium - I look fairly normal I would say
Chubby - I am soft around the edges
Overweight - I am overweight
Obese - I am more than 50lbs over weight
Bottom heavy - top is toned but legs are not
Top heavy - legs are toned but upper body is not.
Prefer not to answer
3
What diets / eating habits have you tried before?* This field is required.Please select all that apply.
Keto
Beachbody
Atkins
Vegan / Vegetarian
Whole 30
No Carb / Low Carb
Gluten Free
Sugar free diets
Weight watchers
Macronutrients
Fasting
Paleo diet
None Of The Above
Other
4
Which of the following describe your current situation best?* This field is required.Please select all that apply to you.
I am trying really really hard with my workouts and my diet, but I can't get freaking toned for the life of me. No matter what I do, I still have a soft fluffy look.
I have no idea any more when it comes to my diet, macronutrients, and nutrition. Everywhere you go someone is saying something different. I have no problem putting in the work.. I just want to know I am doing the right thing.
I was out of shape, and began to make progress, and now my results have stopped and it’s become disheartening. I don't want to fall out of shape again but it's becoming hard for me to keep pushing forward when I am not longer seeing results.
I am using macronutrients, this flexible framework is so intriguing to me, and they are something that have helped me progress. But I am seeing now that there might be more to this than I initially thought... and I want answers.
Food controls me. I am so unsure about what I should be eating, and if I am doing the right thing, that every morning when I wake up, I feel a sense of worry. This is unhealthy and I want to fix it.
I feel like I’m on a roller coaster. I can get in shape but I do it in ways that break me down over time, and I just cant sustain it. I want to learn something sustainable so I can get results that last.
I have been out of shape for quite some time. I need a full on reboot. I need you to believe in me because I am not sure I do any more.
I feel like I am already in pretty good shape. I just want to take things to the next level. I have pushed my experience to the limits of where it can take me and am looking for more.
I am really uncomfortable in my skin, and it is beginning to wear down my confidence levels, and is starting to have a downward impact on other areas of my life.
Other
5
How committed are you to solving this problem today?* This field is required.
5/10 - I don't want to improve my situation that much and am OK not making more progress than I have now
7/10 - I am pretty frustrated with things right now, and want to get them sorted.. I know delay just makes time work against me, and things will continue to get worse / harder to solve the longer I wait.
9/10 - This is effecting my confidence, energy, and how I am showing up in life. I want to fix this ASAP!
10/10 - I will literally do anything to get this situated, I do not want to go on one day longer without a sustainable, healthy, long term program that will improve my body composition, and make me feel better.
6
Rate your current satisfaction level with your body at this exact moment.* This field is required.Slide the smiley face.
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6
Row 0, Column 0Row 0, Column 1Row 0, Column 2Row 0, Column 3Row 0, Column 4Row 0, Column 5Row 0, Column 6
7
Where would you like to be 6-12 months from now?* This field is required.Please select all that apply to you.
I want to feel like I am in control of my body and the way it looks.
I want to feel free from food and the mental chatter that comes with not understanding it.
I want to feel like I can do this myself, and am not dependent on a trainer / nutritionist.
I want to drop 10-15 lbs of fat
I want to drop 20+ lbs of fat
I want to add lean muscle tone
I want to enjoy a body that commands respect
I want to live a healthy lifestyle that deserves respect.
Other
8
What is holding you back from achieving these goals?* This field is required.Please select all that apply to you.
I have a hard time sticking to a diet... I think because I have a hard time believing it'll work long term.
I can stick to a diet, they just always stop working after a certain point, and then I quit them.
I have no problem putting in the work, I just am not sure on what I am supposed to do!
I have trouble trusting the process and need something full proof that I can understand myself.
I don't have the right knowledge. The confusion is causing inaction and I am done with it.
I have a hard time committing and need a heavy element of accountability & support.
I don't have a community or people around me who think like me and can support me.
I don't have any expert coaches, or advice that helps me get back on track.
9
Permission to vent - what has been the most frustrating part of your fitness journey so far? (We find the most successful clients are totally honest here)* This field is required.
10
If you could wave a magic wand and transform your body in 90 days, what would you see in the mirror? How would your clothes fit? How would you feel? (Be as specific as possible)* This field is required.Please be as descriptive as possible to help us tailor your body transformation call...
11
Are you prepared to take action RIGHT NOW to invest significant time, energy, and finances in yourself to reach your goals if you knew with 100% certainty that you would get there?* This field is required.
Yes, absolutely! No, I am not ready yet.
12
If you're accepted into our program how soon can you get started?* This field is required.
13
On my journey to get healthy fit and toned I’ve already invested…* This field is required.
Less than $1,000
$1,000 to $5,000
$5,000 to $10,000
$10,000 to $20,000
$20,000 or more
14
Name* This field is required.
First Name
Last Name
15
Age* This field is required.
Age
16
Email* This field is required.
example@example.com
17
What mobile phone number can we use to reach you? (just so we have the right one on file)* This field is required.By entering your phone number, you consent to receive messages for this event via SMS. Message and data rates may apply. Reply STOP to opt out.
Area Code
Mobile Phone Number
18
Setter
19
Affiliate
20
Spots
21
Hyros Tracking El
22
hubspotutk
23
utm_term
24
Referrer
25
utm_campaign
26
utm_source
27
utm_medium
28
utm_content
29
_fbc
30
_fbp
31
user_agent
32
handl_ip
33
traffic_source
34
handlID
35
h_ad_id
36
handlID
37
fbc_id
38
handl_ref
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handl_url
40
gclid
41
wbraid
42
gbraid
Should be Empty: