2025 Jotform Client Assessment

TRANSFORMATION BEGINS HERE

LIVE LONGER. MOVE BETTER. FEEL UNSTOPPABLE
Full Name*

First Last
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Instagram*
I want to lose weightIncrease my energyTone up and Build muscleOther (please specify)
How many glasses/bottles of water do you drink a day? (On average)*

1

2

3

4

5

6

7

8

1 is One daily, 8 is I love water!
NoYes
If yes, what did you try and what were the results?
I start strong, but I lose momentumI feel tired or drained most daysI don't have real support or guidanceI didn't see results fast enough and gave upLife got in the way, to many priorities
Any dietary preferences or restrictions*
Very important, to create custom plan
Typical day of eating? (Please add cost of each meal $$)*
If no put NA
30 days60 days90 days
$99$99 to $199$200 to $399$400 to $699
On a scale of 1 to 10, how committed are you to achieving your wellness goals?*

1

2

3

4

5

6

7

8

9

10

1 is Lowest, 10 is Extremely
Preferred accountability style?*
Do you want me to let you slack, or NOT accept any excuses and be on you tough?
Confirm I'm READY to fully commit to this process and understand progress depends on my consistency.
Best time to contact you?*
Please give couple time slot options
After helping thousands of people transfrom their lives, there's one thing I've learned--that you are unique. Your journey is like no one else's, so let's create a plan just for you. -Style Bell
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TRANSFORMATION BEGINS HERE