Language
English (US)
Health Assessment:
Fill this out so we can make sure to set you up for success tailored to YOUR needs.
Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
What country do you live in?
Are you a coach or currently working with a coach?
If you knew failure wasn't an option, where would you like to be in 3 months? Think physically, mentally, emotionally, life goals, etc.
Are you willing to invest in a fitness & nutrition program so I can coach you towards achieving your goals? *
What are your health & fitness struggles currently? (I want to know about your digestive health, energy level, weight loss/gain goals, hormonal imbalance, pain, inflammation, etc.) *
On a scale of 1- 10 (1- being cannot get up in the AM and 10 being thriving energy all day) rate your energy level:
Rate your digestive health 1 (poor) to 10 (excellent):
Please rate your level of confidence and ability to be successful:(1 - I don't believe I'll ever be successful. 10 - I know I'll be successful, I have zero doubt.)
What are your biggest barriers to reaching your goals, why have you not been successful in the past? *
Give me a glimpse into your nutrition in a day! What do you eat, when and how much. Are you a stress eater? Chronic dieter? Do you feel guilty when you splurge? How is your self control? Please include ANY supplements that you are currently using. (protein shakes etc)
What is your current fitness level? *
Beginner
Intermediate
Advanced
What kind of workout/movement have you enjoyed in the past?
*
Would you be interested in a micronutrition superfood shake that could fill in a meal for you AND meet your basic greens needs for the day?
*
Yes please!
I'm not sure.
No.
Would you be interested in doing a 3-Day Cleanse to jump start your metabolism and help you clean out a bit first? *
Yes
No
Maybe
Are you interested in a plant based pre-workout/energy booster? *
Yes! Lemon
Yes! Fruit Punch
Yes! Mixed Berry!
No
Maybe
Are you interested in a post workout recovery formula designed to reduce post workout soreness?
*
Yes!
No.
Maybe?
Are you interested in a clean-eating plant based Protein snack bars? *
Yes!
No.
Maybe?
Do you struggle with the infamous afternoon slump sensation and want something that can help you stay FOCUSED and ENERGIZED the rest of your day that is gentle on your adrenals?
*
OMG YES!
No, thanks.
Maybe!
Do you struggle with dehydration and find yourself feeling like no matter how much water you drink, you just cannot feel hydrated enough?
*
YES!
Somtimes.
Not really.
Do you have any immediate questions for me that are really pressing for you?
*
Are you willing to give me your ALL in a focus group for at least 30 days to change your life?
*
HELL YES.
I'm not sure.
No.
What kind of support do you feel you'd need from me as your coach?
*
Weekly email.
Weekly text message.
Monthly check in (email or text)
Daily motivation check in via Telegram/Voxer.
Are you interested in joining our team of health coaches and building a business of your own? *This can be as part-time or full-time as you'd like. We have everything set up for you to help you be successful! We know how to make anyone successful whose WILLING to learn! *
Yes!
Maybe!
No.
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