First Name *

Last Name *

Email *

Phone

Instagram Handle *

What is your daily activity level? *

Select answer

• No exercise at all
• Moderate (desk job, exercise 1-2 times per week)
• Active (e.g. retail work, exercise 3-4 times per week)
• Very Active (e.g. manual labour, exercise 5-6 times per week)
• Athlete (intense exercise everyday)
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• List is empty.

Do you exercise for a specific goal? *

What (if anything) is stopping you from achieving this goal? *

Would you benefit from guidance with your exercise/training routine? *

Select answer

• YES
• NO
• MAYBE
• UNSURE
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• List is empty.

Which statement best describes your eating habits?

Select answer

• I eat what I want, when I want (intuitive)
• I am somewhat conscious/ controlled with my diet
• I am very careful and restrictive of what I eat
• I eat "well" during the week but struggle on weekends
• Other
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Would you benefit from guidance with your daily food intake and eating habits?

Please be specific as possible

• YES
• NO
• MAYBE
• UNSURE
• No elements found. Consider changing the search query.
• List is empty.

If YES, what type of food/diet support would be most helpful?

Do any of the following apply? 

I am pregnant

I have given birth in the last 6 months

I am currently breastfeeding

None of the above

What do you feel is currently holding you back from feeling your best – physically or mentally?

On a scale of 1–10, how confident do you feel in your body right now – and what would it take to move closer to a 10?

What does a ‘healthy lifestyle’ actually look like for you – not what you’ve been told it ‘should’ look like?

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