First Name

Last Name

Phone *

Email *

Are you interested in getting in control of your body and the way it looks for the rest of your life?

Yes

This year, I am…

In my 30's and ready to improve my body composition

Turning 40 and embracing the exciting new chapter ahead

Between 41-45, feeling motivated to prioritize my health and happiness

Between 46-50, eager to rediscover my vitality and zest for life

Between 51-55, excited to invest in my well-being and enjoy every moment

Over 50, committed to feeling my best and living life to the fullest

I want to...

Feel strong and confident in my body

Boost my energy levels to keep up with my busy life

Enjoy an active lifestyle without limitations

Improve my overall health and prevent future issues

Rediscover passions and activities I used to love

Be an example for my children & family

Select ALL that apply

I wish to...

Rediscover activities I used to love but haven't had the energy for

Feel confident and comfortable in my skin

Have more stamina to keep up with my family and responsibilities

Overcome the obstacles that have held me back from being my best self

Embrace a healthier lifestyle without feeling overwhelmed

Select ALL that apply

Sometimes I find it challenging to...

Balance work, family, and time for myself

Stick to an exercise routine due to my busy schedule

Fine motivation when I'm feeling tired or stressed

Prioritize my needs without feeling guilty

Navigate the overwhelming amount of health information out there

Select ALL that apply

I often find myself...

Put others' needs before my own health and well-being

Feel overwhelmed by low testosterone affecting my mood

Facing constant cravings that interfere with my health goals

Frustrated by fitness advice that seems outdated or irrelevant

Worrying about how my body is changing as I get older

Select ALL that apply

Once in a while, I...

Feel unseen or less valued because of how I look

Discouraged, wondering if I've missed the chance to make a real change

Nervous in social settings because I'm self-conscious

Feel isolated, like others don't understand what I'm going through

Curious about professional help but unsure of where to start

Select ALL that apply

I am..

Struggling with weight gain despite my best efforts

Experiencing joint pain or physical limitations that hinder activity

Feeling less attractive or confident in my own skin

Battling fatigue that affects my daily life

Worried about health issues and not aging gracefully

Select ALL that apply

I have...

Tried various diets and exercise without lasting results

Noticed that my metabolism isn't what it used to be

Concerns about low testosterone that impacts my body and emotions

Difficult managing stress, leading to emotional or stress eating

Felt discouraged by the lack of progress despite my efforts

Select ALL that apply

I can't seem to...

Find a sustainable routine that fits into my life

Overcome the barriers that keep me from reaching my goals

Regain the energy and vitality I once had

Feel comfortable and confident in my own body

Shake the feeling that aging is working against me

Select ALL that apply

The thing I'm afraid of is...

That I'll never feel like myself again

That my health will continue to decline as I age

That I'll miss out on life experiences due to my health

That I won't be able to enjoy activities with my loved ones

That I'll always feel uncomfortable in my own skin

Select ALL that apply

What would you like to achieve instead?

I want a personalized plan that understands my unique needs

I wish to feel energetic and vibrant every day

I desire to regain confidence and love how I look and feel

I aim to overcome these challenges and embrace life fully

All of the above--I want to transform my health and happiness

Select ALL that apply

On my journey to get healthy, fit and toned I've already invested..

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