First Name *

Last Name *

Phone *

Email *

Facebook/Instagram Usernames

How did you hear about ShapeShift?

Occupation *

Age *

Weight *

What is your goal? Lose 20 lbs? Gain 20 lbs of muscle? Overcome depression, anxiety, etc.? Lean how to manage Stress? Be Specific. Doesn't just have to be a physical goal. *

What would be the most important criteria for your success as we work together? *

Is your health valuable to you? Be HONEST. You will not be considered for coaching if you do not. If you say YES, explain why below. *

Have you tried in the past to achieve your goals and why hasn't it worked for you? OR if it did work explain why coaching would help you? What's stopping you from hitting your goal? *

On average how much money do you spend on coffee & energy drinks each week? If none put N/A *

On average how much money do you spend eating out each week? If none put N/A *

On average how much money do you spend on alcohol each week? If none put N/A *

On average how much money do you spend smoking each week? If none put N/A *

On a scale of 1-10...1 being I'm satisfied where I am and 10 being I'll do anything to reach my goal. What number are you? *

I am only willing to work with people who are READY to financially invest in themselves. Are you ready RIGHT NOW to make the decision? *

Yes

Are you willing to invest $300+ per month on YOURSELF? *

Yes

Does your spouse or significant other support you? (Meaning they will give you a thumbs up on whatever you decide) *

Yes

N/A or No Spouse/Significant Other

What would you expect from me as your coach if we decide to work together? *

Why do you think you would benefit from 1-1 specialized coaching and/or why would you be a good addition our team? *

What would be GOOD about changing? If you changed, how would it be helpful or beneficial? What new opportunities and possibilities could open up? *

What would be BAD about changing? If you changed, what might you have to give up or lose? How would your regular routine be interrupted? *

What might be BAD about NOT changing? If you didn't change, what bad things could happen? *

If you keep going the way you're going, what might things look like in the future? (say 10 years from now?) *

My program is about educating you on WHY we do what we do. My goal is to teach things that you will carry on for the REST OF YOUR LIFE. I'm not here to sell you on a program and never talk to you like a lot of these other influencers these days.

This investment in yourself. It is not the cheapest but I WILL solve your issues FOREVER. After the program, you will NEVER need another coaching program again because I'll teach you every last trick in the book pertaining to diet and exersice.

With that said, are you ready RIGHT NOW to move forward? (Be ready to move forward after completing this form or consultation IF YOU and me decide you're a good fit for this program.) *

Yes - LETS GO!

If accepted how soon are you looking to get started? (if you aren't ready please just wait and schedule when you can. I can expect those who feel it's a fit to move forward. Those who don't take actions are 95% more likely to continue down their current path). Remember this: WINNERS take action and worry about the rest later. *

After completing this form, how would you prefer to move forward? Choose the option that works best for you. (Please be sure you’re in a quiet, distraction-free environment when watching or joining.) *

Personalized Video Consultation – I’ll record a detailed video walkthrough, so you can watch at your convenience and rewatch anytime.

Google Meet Call – A live, face-to-face conversation where we can dive into your goals and questions together in real time.

Are you Former/Active Military/Police/Fire/First Responder? If so, specify. *