What's your current weight (in lbs)?

Weight *

How tall are you?

Feet *

Inches *

How would you describe your activity level?

Sedentary = Office Job

Light Exercise = 1-2 days/week

Moderate Exercise = 3-5 days/week

Heavy Exercise = 6-7 days/week

Athlete = 2x/day

Activity Level *

Which one best describes your goals?

Fitness Goals *

Build Muscle

Lose Weight

Lose Body Fat %

Maintain Weight

And how mentally, financially, and physically committed are you to reaching these goals on a scale of 1-10?

Commitment *

We're almost there! Just so I get a better idea of your time and availability to commit to your goals, what is your current job title / responsibility level?

Occupation *

And what have you tried in the past?

Past Exp *

I've honestly been inconsistent, but I am ready for a change!

I've tried some diets and haven't had luck.

I've tried working out and haven't had luck.

I've tried dieting & Working out but haven't had any luck.

I've worked with a coach in the past but it wasn't the right fit

Great! I've got what I need to build your target daily calories.

Honestly though? No form can capture everything that's personal to you. Your hormones, your history, your real life, I don't want to just hand you an arbitrary number and disappear. That feels misleading and wrong.

So, if you'd like.. I will personally reach out and help you get the answers you deserve. There's no pressure and it's free! You'll still get your estimate either way 💛

Want a hand with it?

Help Offer *

Yes! I'd love your help 💛

I'm not totally sure what I need, but I'll take my estimate 💛

No thanks, I'm hitting my goals just fine by myself!

We're all set! I can't wait to learn more about you.

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Drop your information on the next slide and we'll get you the helping hand you deserve 💛

(The calorie estimate too, of course.)

I totally understand not being sure where you stand, everyone's been there! 💛
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Now let's get you set up and on track, let me know where to send your results on the next page and I'll send them over instantly!

No worries! I totally respect figuring it out on your own 💛
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Drop your information on the next slide, and we'll send you the calorie estimate right away!

Full Name *

Email *

Phone *

By checking this box, I consent to receive non-marketing text messages from Empower Health and Fitness about my fitness goals. I also consent to receive marketing and promotional messages including special offers, discounts, new offer updates among others. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

What's your current age?