First Name
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Last Name
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Email
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Phone
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What's your IG/FB handle?
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Age?
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What are your health & fitness goals? Lose weight? Be happy and healthy? Tone up? Build muscle/ strength? Overcome depression and anxiety? Fix gut and hormone problems? Manage stress? Be more confident? etc. (Explain in depth)
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On a scale of 1-5, how ready / committed are you to changing your life right now? (1 being "not ready at all" and 5 being "I'll do anything to change my life")
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1- I could put this off for awhile
2
3
4
5- I want this change now!
Were you referred by anyone? If so, please write their name
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If we decide this program is the right fit for you, would you be willing and able to invest in your health and fitness?
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Yes - I have the cash flow to invest in myself
Yes - I may or may not have the cash on hand, but I can get resourceful and/or have access to credit
No - My cash flow is month to month, and I have no access to credit.
Do you need to discuss this investment with your significant other before making a commitment?
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No, I have my own finances/ their support
Yes, they need to be involved
Complete