*1.Full Name(Required.)

*2.Email Address(Required.)

*3.Age(Required.)

*4.Gender:(Required.)

Female

Male

*5.Do you have at least 15 pounds to lose?(Required.)

Yes

No

*6.What's your exercise level?(Required.)

Beginner

Intermediate 

Advanced

*7.What are you hoping to experience from this coaching program? (Check all that apply)(Required.)

Fat loss

More energy

Clothes fitting better

More confidence

Other (please specify)

*8.What's your #1 frustration right now?(Required.)

Info-overload

Can't find a plan that is customized for my lifestyle

I need accountability

I jump from one diet or exercise plan to another

Other (please specify)

*9.Are you willing to work together on specific, measurable, WEEKLY goals?(Required.)

Yes

No

*10.Will you commit to a WEEKLY "Accountability Check-in"? (exceptions such as vacation are OK) Note: you'll be able to communicate with me at any time, but will be REQUIRED to do a weekly check-in.(Required.)

Yes

No

*11.Are you willing to be transparent with me so we can dial in a specific action plan to remove the obstacles keeping you from achieving your ideal weight?(Required.)

Yes

No

*12.Are you willing to commit to this program for a minimum of 12 weeks?(Required.)

Yes

No

*13.Are you serious enough to financially invest in this unique coaching program?(Required.)

Yes, I have the financial resources needed to invest in myself

I can get the financial resources needed to invest in myself

No, I am not ready to financially invest in myself at this time

Please note that all applications are reviewed personally by me. Please allow up to 5 business days for review. Approved clients will be notified from me personally. Premium coaching is currently just $297 billed every 30 days. This is subject to change.