First Name *

Last Name *

Phone *

Email *

What are your fitness goals? (ex: lose 10lbs, gain muscle and strength, have a better relationship with food). Be specific. *

What is your current occupation and how long have you been doing this? *

If you were to find a way to create your dream body, feel healthier than ever to keep your results for life - would you be willing to invest in getting the help necessary to get there?

Do you have a significant other? If so, are they supportive of you potentially investing in your weight loss, health, and personal growth? *

Yes, I have a significant other and they are super duper supportive.

Yes, I have a significant other, but this is my decision to make.

Yes, I have a significant other, but they may need to be on the call with me to make a joint decision.

No, I’m single and make my own rules.

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