GoodeFit Health & Wellness Program

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Full Name* This field is required.
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Email Address* This field is required.
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Phone Number* This field is required.
Area Code
Phone Number
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Instagram Profile Link or Facebook Profile Link* This field is required.
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Age* This field is required.
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Date of Birth* This field is required.mm/dd/yyyy
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What is your full address?* This field is required.Please include house/unit number, street name, city, state, & zip code:
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What is your current height?* This field is required.
Feet & inches
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What is your current weight?* This field is required.
lbs (pounds)
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What is your current activity level?* This field is required.
Sedentary: I sit down most of the day and rarely exercise.
Light Activity: I spend a good portion of the day on my feet and sometimes exercise.
Active: I perform physical activities and workout often.
Very Active: I workout 4-5 times per week, and am always active.
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From the following, please select the items that best align with your health and wellness goal(s)?* This field is required.Select as many that apply:
Weight loss/Fat loss
Better overall health and wellness/Healthier lifestyle
To eat healthier
To feel attractive & confident in my own skin
Muscle toning
To be in less pain
To feel less sad/depressed about my body or health
All of the above
Other
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Please select ALL that apply to you. Please ensure all responses are as accurate as possible and to the best of your knowledge.* This field is required.Select all that apply.
A doctor has told me I have a heart condition and/or that I should only perform physical activity recommended by a doctor.
I feel pain in my chest when I perform physical activity.
In the past month, I experienced chest pain while NOT performing any physical activity.
Sometimes, I lose my balance because of dizziness and/or I sometimes lose consciousness.
I have a bone or joint problem that could be made worse by a change in my physical activity.
My doctor is currently prescribing medication for my blood pressure and/or for a heart condition that I have.
There are other reasons why I should not engage in physical activity.
None of the above apply to me. I have been cleared by a doctor and/or primary care physician to engage in physical fitness activity.
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Describe any other medical related conditions or situations you're currently experiencing and/or that you've experienced in the past, such as past injuries or chronic pains, medications, pregnancy complications if applicable, hypertension, diabetes, allergies, surgeries, or any other medical related conditions or situations.* This field is required.Feel free to be as specific as possible:
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Regarding smoking and alcohol consumption, please select all that apply to you:* This field is required.Select all that apply.
I smoke sometimes, but not often.
I usually smoke multiple times weekly.
I drink socially, but otherwise I do not drink.
I usually drink multiple times weekly.
I do not smoke at all.
I do not drink at all.
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Regarding COVID-19, please select all that apply to you:* This field is required.Select all that apply.
I have traveled to countries outside of the United States and/or have been in close contact with someone who has traveled outside of the United States within the last 14 days.
I have had close contact with and/or have cared for someone diagnosed with COVID-19 within the last 14 days.
I have experienced cold or flu-like symptoms in the last 14 days (cough, fever, shortness of breath, loss of taste and/or smell, or other respiratory problem).
None of the above apply to me.
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What do you do for work?* This field is required.Feel free to be as specific as possible:
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Describe your current eating habits:* This field is required.Feel free to be as specific as possible:
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As it pertains to bettering your overall health and wellness - describe your goals and ideal outcome:* This field is required.Feel free to be as specific as possible: e.g. Feel more secure with my body, be stronger, feel less out of breath, eliminate love handles, tone my shape, desired weight, etc.
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Being completely honest with yourself, what do you think has been the biggest obstacle stopping you from achieving your desired and ideal outcome?* This field is required.Select as many that apply
I don't know where to start.
I need someone or something to hold me accountable.
I need structure.
I have trouble being consistent after I start something.
I'm scared to try because I'm scared to fail.
All of the above
Other
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Have you ever officially worked with a certified trainer/coach under a structured program?* This field is required.Select as many that apply
Yes
No
Other
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It is possible that you may have never invested in working closely with a coach, and that’s totally okay! We’re very empathetic to our clients’ lifestyles, and even billionaires have budgets. That said, please select from the following custom plan ranges. Choosing an option does not commit you to anything; it just gives us an idea of how we can best serve you within your price range.* This field is required.
Basic Plan: $99 - $499 (usually best for you if you just need a little bit of direction)
Gold Plan: $499 - 1999 (usually best for you if you require a little bit of direction, plus some additional hand holding)
Platinum Plan: $1999 - 4999 (usually best for you if you want a slight transformation, want to tone, gain and lose inches in certain areas, and need structure and accountability to help you get there)
Diamond Plan: $4999 - 7999 (usually best for you if you have a major long term goal that you feel will take a lengthy commitment to achieve)
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Are you fully committed and ready to take action towards better health and wellness for yourself?* This field is required.
Yes, absolutely, 100%, ready right now to make a change!
Yes, but this is new for me and I'm still kind of nervous. I'll need top notch accountability.
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Thank you!
After hitting the SUBMIT button below, you'll be all set, and we'll have everything we need to contact you regarding next steps!
Should be Empty:

Thank you! After hitting the SUBMIT button below, you'll be all set, and we'll have everything we need to contact you regarding next steps!

Thank you!
After hitting the SUBMIT button below, you'll be all set, and we'll have everything we need to contact you regarding next steps!