This super quick form will help you figure out your target calories, and you'll get your results instantly! I'm so excited to take the first step with you to achieving your goals!

To get started, Simply follow along and answer the questions!

(Heads up, this is for the girls only!)

What's your current age?

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

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 *

Just so that I have a better idea of where to start, and give you the best answer, what have you tried in the past with your health and fitness goals??

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.