Health & Performance Coaching

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
We'd love to hear about your specific conditions / injuries / health struggles that you're looking for help with. Please give us a quick rundown on your situation.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
5
If we could wave a magic wand and help you achieve ONE thing, what would it be? How will achieving this outcome improve other areas of your life?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
6
What are you currently doing to work towards this goal? Include how much time and money you've invested in reaching these goals. * This field is required.
Huge
Large
Normal
Small
Ok
Ok
7
Why is it important for you to get help with this?* This field is required.Select all that apply.
It's severely impacting my everyday life
It's impacting my training
It's stopping me from doing the things I love
I've put it off for far too long
My health is important to me
I just want to get fitter and stronger
8
What services have you tried in the past?* This field is required.Select all that apply.
Physio / Physical Therapy
Massage
Chiro / Osteo / Myo
Medication
Injections / Surgery
Another Health Professional
Gyms / Group Fitness
Personal Trainer
Dietician / Nutritionist
Psychologist /Mindset Coach
9
The Longevity Project™ covers a lot of bases, which parts of our program are you most interested in? (Optional)Select all that apply.
Exercise / Fitness
Accountability / Motivation
Injury Rehabilitation
Education / Knowledge
Nutrition Meal Planning
Chronic Condition Management
Improving Sleep Quality
Ergonomic Advice & Assessment
10
Is there anything holding you back from joining our Health & Performance Coaching program?* This field is required.
Finances
Commitment
Time
Nervous / Anxiety / Fear
I'd like more info first
Nope, I'm ready to take action!
11
Given everything going on in your life right now, how important is it for you to achieve the goals you listed above? (0-10)0 = Not important at all, 10 = Extremely important.
12
If we are a good fit, how long are you looking to commit to working with us to achieve an incredible result together?* This field is required.Note: Our current minimum program length is 6 months (with up to 2 weeks on pause). If you are unable to commit to this, we may determine you aren't a good fit to to work with us (and will chat with you about this before needing to make a decision).
12 months
6 months
As long as it takes!
13
If you were able to find a way to create a healthy, active body not just for now, but for life - Would you be willing (and able) to invest in getting that help NOW?* This field is required.
Yes - I have the money to invest
Yes - I may or may not have the cash to invest, but I'm resourceful and have access to credit &/or funding.
No - But I'm willing to get creative
No - I have no cash reserves, no access to credit and I'm unwilling to get resourceful
14
Is there anyone else you'd like to be involved in helping you make a decision before committing to our Health & Performance Coaching Program (ie. partner?)* This field is required.We want to ensure all parties who are important enough for you to want to discuss this decision with are also able to be present for any calls. If there are people who cannot make the call, please understand that we will reschedule your call time until they can be available.
Yes - I will ensure they are also able to make the call to be a part of the decision-making process
Yes - But the decision is ultimately mine to make
No - I know I'll be able to make a decision myself
15
How did you hear about Longevity Project Australia™?* This field is required.
Google Search / Website
Social Media @longevityprojectau
I'm a previous client
Walked Past Clinic
AFFILIATE: Hanah Mills
AFFILIATE: Carla Butler
Other
PARTNER: Beny
16
Did someone refer you? If so, who? And is there anything else you'd like to tell us about you and what you're after before booking in your Deep Dive Call? (Optional)
Huge
Large
Normal
Small
Ok
Ok
17
If we decide we would work well together, when would your ideal start date be?* This field is required.
Date
Day
Month
Year
18
How would you prefer us to contact you?* This field is required.
I'll use the video link send with the confirmation
I'd prefer you to call me on the phone
Should be Empty: