Course Registration Form

Health Questionnaire
Name*

First NameLast Name
E-mail*
So what exactly is our wellness group & what do you get? We run these accountability groups through Facebook to help people reach their goals! We really focus on keeping people motivated and accountable so that excuses aren't an issue. You get set up with what YOU specifically need for your goals -- workouts, meal plans, recipes, energy boosts, digestive health, etc! Here's a sneak peek!
Where do you live?*

United StatesUnited KingdomCanadaFranceOther
What would you like to achieve through this group (lose 10lbs, gain muscle, etc) + what is motivating you to start right now?*

How would you rate your current EXERCISE?

	1	2	3	4	5

1 is Worst, 5 is Best

How would you rate your current NUTRITION?

	1	2	3	4	5

1 is Worst, 5 is Best

How would you rate your current ENERGY levels?

	1	2	3	4	5

1 is Worst, 5 is Best

What are you interested in trying?:

New workoutsMeal plansHealthy snack optionsEnergy boostHelp with digestionA quick detox/cleanse
What do you feel are your biggest obstacles when it comes to getting the results you want? (Choose your top 1-3)

Don't have the timeDon't have the spaceDon't know where to startI struggle from emotional eatingI struggle with confidenceI lack motivationI can't afford anything at all
I do not charge for my coaching OR my groups, but you do need to invest in a program that I will coach you through, to see real progress in your body & mind. Are you willing to invest in a one-time fee of $/£ 40-160 to get everything you need for this program?

AbsolutelyMaybe? Let's chat.No way.
Would you be interested in publicly sharing your fitness journey to inspire others & earn a side income?

Yes!Sure, but not right away.Maybe one day?No way!
Which is the best way to contact you?

EmailInstagram/Facebook messengerEither is fine
Is there anything else I should know about you OR do you have any questions for me?
Should be Empty:

Health Questionnaire