First Name *

Last Name *

Email *

Phone *

Age *

Occupation *

Tell me, what are your current health and happiness goals (body composition changes, health markers, performance, muscle growth, energy...) *

What have you tried in the past in an effort to reach these goals? What worked? What did not work? *

How long have you been on a journey to your ultimate health and happiness? *

< 1 year
1-3 years
5-6 years
6+ years
No elements found. Consider changing the search query.
List is empty.

Rate the following from 1-5:

I tend to get derailed if one thing goes wrong (if I eat something "Bad" it messes up my day. *

1 - Strongly Disagree
2
3
4
5 - Strongly Agree
No elements found. Consider changing the search query.
List is empty.

I regularly am "off and on" the health and fitness wagon - having really good spurts and then really bad spurts. *

1- Strongly Disagree
2
3
4
5 - Strongly Agree
No elements found. Consider changing the search query.
List is empty.

I have a hard time being consistent because of my all-or-nothing attitude towards eating and working out. *

1 - Strongly Disagree
2
3
4
5 - Strongly Agree
No elements found. Consider changing the search query.
List is empty.

I make healthy habits a priority *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

I exercise daily *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

I plan most of my meals *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

I eat with few distractions and mindfully *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

I make time to relax, destress and have fun! *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

I eat fruits and veggies at most meals *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

I prioritize protein at most meals *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

I eat whole, minimally processed foods *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

How many hours of sleep do you get in a night? *

Do you currently track your food? *

If YES, what is your average caloric intake?

Do you drink or smoke? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

I have at least one supportive and positive social connection *

1 - Never
2
3
4
5 - Always
No elements found. Consider changing the search query.
List is empty.

Do you take any medication - Please List. *

Why do you want to get help with your healthy habits and lifestyle changes? *

Who else would this benefit? *

In your own words, please type what you're feeling and what you're having the hardest time with right now and what you'd like to change over the next year. *

Lastly, why do you think you'd be a good fit for a program like ours? *

Thanks for filling this out! It helps us understand you, your history, and your goals a lot better.

(Our program is NOT a weight loss program. If you’re looking to drop a quick 10 lbs, we’re not the gals for you. We do, however, help women establish the foundation for healthy living, long term body composition changes, and ultimate health and happines (whatever that looks like for you). )

Our DIY Program starts at 75$/month and 1:1 Coaching starts at $375/month

Are you interested in discussing our coaching program options? *

YES, absolutely interested

Not sure yet

No, I'm looking to drop weight quickly and I'll look elsewhere

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.