Empowered Coaching Application Form

For busy, high achieving women who are ready to ditch the quick fixes and create a lifestyle change. Women who have tried it all with little to show for it, or find that what used to work, no longer does. Who want to lose fat and see visible muscle definition by optimizing your metabolism and hormones.

To confirm, you are filling this out because you want to lose between 10-25lbs of stubborn fat, regain energy, optimize hormones, build lean muscle + make this the LAST COACH you’ll ever need? *

Yes - I am serious, and want to learn more about reaching my dream body, without sacrificing my life.

No - I’m going to leave this page immediately.

Full Name *

What is your primary goal? (Be as specific as possible) *

Why is achieving this goal important to you right now? *

What have you been struggling with on your own to achieve this goal? How long have you been struggling with this? *

Age? *

On a scale of 1-10, with 1 being I am content with my current body and health and 10 being I need to make a change now, where do you fall? *

What makes you interested in working with our team specifically? *

Because I’ve followed you for a long time, and witnessed the amazing success stories and transformations, and hope to be your next success story!

Because I want to utilize a proven method that will address the underlying root causes of my weight loss issues, instead of being told “eat less, and move more.”

Your support, knowledge, and accountability allows me to fully trust that you will be the last coach I’ll ever need.

All of the above

I’m not very familiar with your program, but I am interested in learning more!

What is your current occupation and how long have you been doing it? *

If we were to find a way to reach your dream body, optimize your health, and learn how to keep your results for LIFE, making this the last coach you'll ever need - would you be willing (and able) to invest in getting the help necessary to get there *

Yes, I have the cash flow to invest in myself.

Yes, I may or may not have the cash flow but I'm resourceful and/or have access to credit.

No, my cash flow is month to month and I have no access to credit.

Email *

Phone *

Please confirm your mobile number [It's really important this is correct so that we can confirm your application + help you book your free strategy session]