Burnout to Balance Waitlist Application 🌿✨

1

Full Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Instagram Handle

4

What are your current health or fitness goals, and what challenges are you facing right now?* This field is required.

5

Which mindset struggles do you relate to? (Select all that apply)* This field is required.

Perfectionism

All-or-nothing thinking

Emotional eating

Self-sabotage

Inconsistency

Lack of confidence

Difficulty staying on track

Other

6

What have you tried in the past, and why do you feel it hasn’t worked for you long term?* This field is required.

7

If you could achieve your dream result in the next 6–12 months, what would that look and feel like for you?* This field is required.

8

How ready and committed do you feel to making lasting changes to your habits, mindset, and lifestyle?* This field is required.

I’m 100% ready and committed

I’m motivated but a bit nervous

I want to, but I have doubts

I’m not sure yet

9

Are you looking for quick results, or are you genuinely willing to focus on sustainable progress and lifestyle change?* This field is required.

I want quick results

I’m open to a slower, sustainable approach if it means lasting change

I’m not sure

10

Tell us about your lifestyle: work schedule, stress, sleep, and support systems (friends, family, community, etc.).* This field is required.

11

Is there anything else you’d like us to know about your journey, challenges, or hopes? (Optional)