Healthy Eating Revolution (H.E.R.) Application Form

Welcome to H.E.R.! Well done - you have taken the first step to achieving your goals. Once this form is completed and you click on 'submit', a Thank You Form will appear with a link for you to book your FREE strategy call to see if we are the right fit for each other. LETS DO IT SISTA!

Please note - we do have a current waitlist however let's get the ball rolling!
Your Details:

Please complete the below in as much detail as possible. Please note - only I see this form so please be as honest and open as possible so I can help you to the best of my ability.
Full Name*

First NameLast Name
City / State
Phone Number*
E-mail
example@example.com
What are your current goals?
Are you looking to lose weight?
If yes - How much do you currently weigh and how much do you want to lose?
Are you looking to put on weight?
If yes - how much do you currently weigh and how much do you want to put on?
Do you currently suffer from a distorted view on food? ie: fear of food, binge eating
If yes - Please explain and include current & past habits / challenges with food?
OBSTACLES: What have you tried in the past to reach your goal? Please list any specific diets/supplements/habits etc..
What has prevented you from reaching your goal? Please list any reoccurring challenges.
How much money do you think you spend per week (on average) on things that have caused you to stray away from your health goals such as: alcohol, take away food, "fat loss" supplements, snacks, quick fix solutions, dinners out, cigarettes etc?
LOST MONEY: How much money do you think you have spent per month trying to achieve your goal? Think supplements, diet programs, coaches, waist trainers, subscriptions, etc..
CONFIDENCE: How do you truly feel about your body now? Feel free to be as open and honest as you like
How would you like to feel about your body after my program?
What would achieving your goals mean to you?
What is your insta handle? Let me follow you back!
Why did you apply to LMW's program?
Do you see this as an investment into your future or an expense?

Investment girl!!!Expense :-(
Please explain why you see this as an investment or expense?
Are you ready to create change in your life?
Change is hard but it is possible.

I am ready & know some weeks will be hardI know future me will thank meI am ready to learn strategies for the challenges I face
Are you ready to create change in your life?
Why do you think I am the right coach / mentor for you?
HOW READY ARE YOU TO ACHIEVE YOUR GOALS?

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1 is NOT READY, 10 is LET'S DO IT SISTA!
Congrats and welcome to H.E.R! Well done - You have taken the first step to achieving your goals.

Once submitted, please go to the link on the next page to book in your FREE strategy call.

Can't wait to get to know you and get you on the right path sis! xx
This is an application form ONLY.
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Your Details: