Be Your Best 12-Month Transformation Application
www.beyourbest.nyc
About You!
Full Name:
*
Email:
*
Phone:
*
Age Range:
*
Under 30
30-39
40-49
50-59
60-69
70+
Your Goals?
What are your top 1–3 health or wellness goals right now?
*
What has been your biggest challenge when it comes to your health or weight?
*
How long have you been dealing with these challenges?
*
Less than 6 months
6–12 months
1–3 years
3-5 years
5+ years
Program Fit & Readiness:
Why is now the right time for you to focus on your health?
*
On a scale of 1–10, how committed are you to making sustainable changes over the next 12 months?
*
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
What type of support do you feel you need most right now?
*
Investment Awareness:
This is a 12-month coaching program with an investment of $4,800 or $400/month.If accepted, are you prepared to invest?
Yes
I would need a payment plan
I would like to discuss detains
Important Acknowledgements:
Please acknowledge all Three of the following:
I understand this is a coaching program for education and support, not medical treatment
I understand results require personal effort and consistency
I understand results require personal effort and consistency
Final Thoughts:
Is there anything else you’d like us to know?
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