Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Instagram handle
*
Where do you live? (City, State or Country)
*
What is your current age?
*
What is your height ?
*
What is your current weight ?
*
What do you currently do for work & how active is your job?
*
How much weight do you want to lose
*
0-10 lbs
10-20 lbs
20-30 lbs
30-50 lbs
50 or more lbs
I want to build muscle
Other
What are your primary goals ?
*
Lose 20 lbs or LESS
Lose 20 lbs or MORE
Decrease Bodyfat
Improve Fitness
Get off Medications
Lose Belly fat
Tone Up
Improve my Health
Improve my self-image
Other
Any health issues ?
*
Diabetes
Blood Pressure
Cholesterol
Depression
Cancer
Joint Pain
None
Other
What has prevented you from achieving your goals ?
*
Guidance
Accountability
Support
Consistency
I quit on myself
I have hit a plateau
Procrastination
Poor food choices
Not enough exercise
Emotional / Stress Eating
Other
On a scale from 1-5, how ready are you to make this change?
*
1
2
3
4
5
What best describes your primary goals in the next 12 months?
*
Become the best version of myself
Get off my medications
Get healthier
Get toned and defined
Feel better in my own skin
Be able to wear a bathing suit and feel good about what I see in the mirror
Lower my bodyfat %
Other
When you look in the mirror do you like what you see? Why or why not?
Why do you want to work with me?
This program is only for serious individuals who are committed to their fitness, health and weight loss goals and want to see results immediately and permanently
*
Yes, I am ready to change my life
No, I will just stay stuck
I'm looking for individuals who are ready to go all-in. If you’re prepared to commit to 90 days of growth, this is for you!
*
I’m all in. I’m ready to hit my goals and start my 90-day journey
I’m ready to commit, but I'd like to discuss my specific goals with you first
To ensure full alignment and the best possible results, this program requires a 90-day commitment, paid in full at the start. This isn’t just a fee it’s a declaration of your intent to stay the course and finish what you start. By removing the month-to-month guesswork, we can focus 100% of our energy on your transformation
*
I'm all in. I understand the 90-day commitment and I’m ready to invest in my progress today
I’m serious about the 90 days, but I have a few questions about the curriculum before I finalize my payment
Anything else you want me to know?
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