Let's get Healthy!

This will take you just 2 minutes to fill but will allow me to build a profile for you!

I can make the best recommendations after learning a bit about your concerns and goals.

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* 1. This survey allows us to connect you with a Certified Health Coach that will be coaching you in becoming your healthiest self.

What filling this survey means:

1) You are looking to get healthier and have more energy

2) You may need support with your weight management goals

3) You are not looking for a crash diet or starving yourself

4) There is a cost associated with the services and products that will be offered to you by the Health Coach (the first call is a FREE assessment), after which you can decide to continue or not.

5) The package offered will have a 90 day money back guarantee, in case you change your mind later. (This does not refer to any samplers being offered for Free).

Please select which applies to you below.

Yes, please connect me with a coach, I am okay with the above facts.

No, this does not sound like it is for me.

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* 2. Please share the following information for your Profile.

Genetically Male or Female?

Height

Age

Starting Weight

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* 3. What is your main reason for looking into a healthy living program?

Need Support with my Weight Management Goals

Improve Health

Build Muscle

Healthier Lifestyle

Want More Energy

Want to Sleep Better at Night

Want to look and feel more Lean and Fit

Health Concerns (please specify below if you can)

Want to cleanup my Gut

Other (please specify)

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* 4. What are some of the obstacles in your daily life right now that currently prevent you from being your ideal healthy self?

No obstacles, I am ready to begin.

Lack of self control

Limited time to cook healthy meals

Too Socially active

Sweet tooth

Shift work or difficult schedule

Do not stay committed to anything for long

Other (please specify)

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* 5. Which other programs or routines have you tried in the past to try to get healthier?

Keto diet

Soup Diet/Juicing/Limited calories

Dr. Bernstein

Dr. Poon's

Weight Watchers

Gym/Exercise/Personal Trainer

Just trying to eat clean on my own

I have never tried anything before

Other (please specify)

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* 6. What would you ideally like to see happen? (Check all that apply)

Lose weight on the scale

Lose inches around the body so clothes fit better

Maintain my current weight and size, but get my body stronger/healthier

Gain weight/inches to be at a healthy size/weight

Feel free to elaborate here.

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* 7. How actively do you currently exercise?

None

1 to 2 days a week

3 to 4 days a week

5 to 7 days a week

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* 8. Do you currently take any nutritional products to help support your system and health?
For example, like protein, fibre, collagen support, digestion support etc

Yes. Please share which ones in particular.

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* 9. If I could show you how to achieve your goals without giving up delicious food and still feeling fulfilled each day, would you be ready to begin?

Yes! This is what I have been looking for!

I am not sure, I would need more information first about the program and how it works.

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* 10. Where did you come across this Questionnaire?

Instagram

Facebook

On a Website

Google

Personally Sent Link by Sheela

Other (please specify)

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* 11. When is a good time to get in touch with you? (check all that apply)

Morning (9am to 11:30am)

Afternoon (12pm to 4:30pm)

Evening (5pm to 8:30pm)

Late Night (9pm to 11:30pm)

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* 12. Please share your contact information below so that I may get in touch with you to discuss your goals.

First and Last Name

Instagram Handle

City/Town

State/Province

Country

Email Address

Phone Number

Let's get Healthy!

This will take you just 2 minutes to fill but will allow me to build a profile for you!

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* 2. Please share the following information for your Profile.

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* 3. What is your main reason for looking into a healthy living program?

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* 4. What are some of the obstacles in your daily life right now that currently prevent you from being your ideal healthy self?

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* 5. Which other programs or routines have you tried in the past to try to get healthier?

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* 6. What would you ideally like to see happen? (Check all that apply)

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* 7. How actively do you currently exercise?

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* 8. Do you currently take any nutritional products to help support your system and health? For example, like protein, fibre, collagen support, digestion support etc

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* 9. If I could show you how to achieve your goals without giving up delicious food and still feeling fulfilled each day, would you be ready to begin?

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* 10. Where did you come across this Questionnaire?

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* 11. When is a good time to get in touch with you? (check all that apply)

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* 12. Please share your contact information below so that I may get in touch with you to discuss your goals.

* 8. Do you currently take any nutritional products to help support your system and health?
For example, like protein, fibre, collagen support, digestion support etc