First Name *

Last Name *

Phone *

Email *

Where do you live? (City, Country) *Currently only servicing the U.S. & Canada. Do not fill out if you reside outside these two countries. *

How did you hear about us? Instagram? Facebook? Email? Friend? Other? *

What is your current weight?(Lbs, Kilos) *

What is your age? *

How tall are you? *

Occupation? (So we can better understand your daily activity level). *

What are you currently doing for exercise?(Crossfit? Yoga? HIIT? Your own routine? etc.) *

What diets have you tried in the past? *

Over how many years have you tried to lose the weight and keep it off for good? Less than 1 year? 2-5 years? More than 5 years? *

Have you dieted in the last 3-6 months? *

Are you taking any supplements/vitamins? *

Fill in other

What has been the biggest obstacle in achieving the above? *

Why is now the time to solve this pain? *

What would need to happen in a few months/one year for you to look back and think "This was the best decision I've ever made, I'm so grateful I did this."? *

My programs are about teaching, not just ordering you around. I tell clients it's a one-time investment. I'm not the cheapest but I solve your issue forever. After the program you should never need another coach or program again because I'll teach you every last trick in the book pertaining to diet and exercise. With that said are you willing to invest financially and mentally to reach your goals? *

On a scale of 1 - 10... 1 being I'm satisfied where I am and 10 being I'll do anything to reach my goal. What number are you? (This answer is very important, wink, wink) *

What would you expect from me as your coach if we decide to work together? Answer as honest as you can! *

Do you have the ULTIMATE decision making power over your own health and fitness, or do you need someone ELSE’S permission? (Dr, spouse, etc) *