First Name
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Last Name
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Email
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Phone
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Do you promise to answer all the questions below honestly? We can't help you unless you are honest with yourself and our team.
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Yes
No
List 3 outcomes you want to achieve in the next 30 days while working with us. Be specific.
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What or who could hold you back from reaching your desired outcomes? Be specific
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Are you willing to walk away from controllable factors, toxic relationships and tempting distractions that could inhibit your progress?
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Yes absolutely!
I am, but it will be very difficult.
I am not sure. I have failed before.
Probably not. Is there an easier way?
No. I lack willpower.
What fitness goal did you try to reach in the past yet failed at? Why did you fail?
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What was your greatest success with achieving a health related goal in your life? Why did you succeed?
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What tools or assistance could we provide for you that would drastically improve your chances of succeeding? Be specific please.
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If we provide a very clear path to your desired outcome are you financially prepared to invest in getting the results you desire?
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Yes Absolutely!
Honestly, I'm Not Sure.
Probably Not.
When you achieve your desired goal will you let us use your story, photos and testimony to help motivate and encourage others to take the same steps you have taken?
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Yes. Of course!
No. I would not like that.
When you achieve your desired goal will you let other people know where you received your fitness coaching and refer people for us to speak with? Will you help others find joy in being fit?
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Yes absolutely!
No I will not do that.
Do you promise to keep your appointments and follow directions to the best of your ability?
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Yes
No
Please list everything you have eaten for breakfast and mid-morning snacking over the last 48 hours.
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Please list everything you have eaten for lunch and mid-day snacking over the last 48 hours.
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Please list everything you have eaten for dinner and late snacking over the last 48 hours.
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Anything else you want me to know before we talk? (optional)