First Name *

Last Name *

Date of birth (must be at least 21 years old) *

Email *

Phone *

City *

State *

Country *

What Do You Do For Work? (Knowing what you do for a living gives me a context as to who you are and what lifestyle factors will be at play) *

What Are Your Goals? (Describe in your own words) *

What do you feel is the biggest struggle when it comes to achieving your goals? (knowledge, time, stress, accountability, mindset, etc) *

Do you have a significant other? If so, are they supportive of you investing in your weight loss, health, and personal growth? *

Do you have any experience working with an online coach? If so, please elaborate so I can get an idea of what you are looking for to make sure we are a good fit. *

What are the consequences of you NOT making any changes? How will not doing anything about this impact you long term? *

If your desired goals and results from this program were guaranteed and permanent, what would you be willing to invest to become the happiest and healthiest version of yourself? *

Finances aren’t an issue

I have a budget but if the program can guarantee results, I’m in

I have less than $300 to spend

Is there a significant other involved in your decision-making process to start w/ coaching? *

Assuming this is a good fit, are you willing and able to start RIGHT NOW? *

Which best describes your nutrition for the last 30 days? *

Have you been diagnosed with an eating disorder? *

What is it you are looking to gain from having a coach? *

Anything else you'd like to add before booking? *