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You get out what you put in

It's great to have you join the Keto Dash squad. Over the next 8 weeks your success coach will help guide your body into its best shape possible. To get started we need to know a bit more about you. Please fill in as many fields as possible and be as honest as you can.  This form should only take 5 - 10 mins max.

We will not share your specific details with anyone outside of our success team, we just use this information to best understand your current situation, your goals and potential roadblocks so we can best support you.

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* 1. First up we need to grab your First and Last name.  Add your Nickname if you like as well

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* 2. How would you prefer your Success Coach to contact you initially?

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* 3. What is your age range

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* 4. What is your gender?

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* 5. What City do you live in?

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* 6. What is your current bodyweight

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* 7. How much Weight would you like to lose over the 8 weeks?

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* 8. Do you have a long term weight loss goal?  Share this number with us

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* 9. What are the top reasons you would like to lose weight?

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* 10. What are you most looking forward to once you reach your goal weight?

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* 11. What have been the obstacles, if any, you’ve encountered when trying to attain your goals? (Select all that apply.)

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* 12. What is your Marital Status

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* 13. Do you have children?  If so what age are they?  (Check all that apply)

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* 14. Do you work?  If so how many hours per week on average?

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* 15. Have you done Keto before?

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* 16. What other diets have you tried in the past?

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* 17. How successful have your previous diets been?

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* 18. What were the main roadblocks/ barriers you encountered?

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* 19. Did you weight rebound after you left your diet?

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* 20. Do you have any Physical Ailments or Medical issues?

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* 21. Any Allergens or Dietary requirements?

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* 22. What Physical Activities do you currently do and how often?

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* 23. How often do you drink alcohol and how many drinks in an average session?

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* 24. Have you eaten Muscle Fuel before?

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