*1.What is your first & last name?(Required.)

*2.Please list your current email & phone number where you can be reached. (If you must list both or your application will not be valid, this is how I get ahold of you to continue the application process if my program suits you.)(Required.)

*3.How did you hear about this program?(Required.)

Instagram

Facebook

A friend

Other

*4.Which one describes your current fitness routine? (There is no wrong answer, just be honest)(Required.)

Sedentary: little to no physical activity

Lightly active: moderate exercise 1-2 times per week

Active: exercise 3-4 times per week

Advanced: exercise 5+ times per week

*5.What are some of the goals that brought you here today?(Required.)

*6.Which best describes your relationship with food?(Required.)

I restrict myself and don’t eat certain foods

I restrict myself sometimes

I binge

I tend to binge

I have a really bad relationship with food

I feel really good about my relationship with food

*7.Which best describes your diet?(Required.)

Vegan (no animal products)

Vegetarian (no meat)

Pescatarian (no chicken & no red meat)

No Red Meat (only chicken & fish)

No Fish (only red meat & chicken)

I eat everything

Other

*8.Are you ready to financially invest in this program and your goals?(Required.)

Yes

No

*9.After I review your application and if you’re a good fit, when would your ideal start date be? (Note*: applications submitted more than 10 days prior to the start date will not be accepted)(Required.)

*10.I need my clients to want their goals as much as I want them to meet their goals (but really, more!).

I will only be accepting people who are serious about their goals so we don’t waste my time or yours!

Please tell me in the text why you feel you are suitable for this program!(Required.)