Store Locations:
www.wegetresultskentuckiana.com/our-team
www.wegetresultskentuckiana.com
SUBMIT FOR $5 OFF A TRIAL PACK or 50% OFF YOUR NEXT DRINK
For First Time Customers who have never had a wellness evaluation
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
How did you first learn about us?
*
Do you have any general questions or inquiries (how to order products, where is the closest store location, interest in the 5-day eat clean challenge or 21-day body transformation challenge)?
GOAL SETTING
If you're excited to join the next challenge or would like to schedule your free consult, please answer the questions below.
What is your main health goal? (weight loss, muscle gain, more energy)
What have you tried in the past to reach this goal?
When you have tried to achieve these goals before, what has worked for you?
What hasn’t worked for you?
Why do you think it has been difficult for you to achieve your goals?
On a SCALE of 1 - 10 (where 10 is VERY READY) - How ready are you to make changes to your diet and lifestyle?
Why do you want to reach this goal?
On a SCALE of 1 - 5 (where 5 is VERY READY) - How ready are you to make changes to your diet and lifestyle?
Please Select
1
2
3
4
5
I would like to put a plan in action that will help me reach my goal by scheduling my 15 minute wellness evaluation (and Body Composition Testing)
In person, at the store
Over the phone
Over Zoom (video conferencing)
Best way to reach you
By phone
By text
By email
Submit
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