Please Complete This Application
If we don't get an application from you, your booking WILL BE CANCELED. Please BE HONEST.
Name*
First Name Last Name
Email*
example@example.com
Phone Number*
Area Code Phone Number
Your Facebook Profile link (or your full Facebook name):*

What is your goal? Lose 20 lbs? Gain 20 lbs. of muscle? Overcome depression? Be specific. Doesn't just have to be a physical goal.*
What would be the most important criteria for your success as we work together?*
What have you tried in the past and why hasn't it worked for you? What's stopping you from hitting your goal?*

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?*
Are you willing to use a credit card, paypal credit, or loan if you feel it's what you need?*
Does your spouse or significant other support you? (Meaning they will give you a thumbs up on whatever you decide)*
Yes No Not applicable

What would you expect from me as your coach if we decide to work together?*
Space is very limited and I want to make sure this is a good fit, why do you think you would benefit from a call or be a good addition to our mentorship, if invited?*

My programs are about teaching, not just ordering you around.
With that said, are you willing to invest financially to reach your goals? (Be ready to move forward on the call IF YOU and me decide you're a good fit for this program. IF you are not a good fit I will let you know and refer you to someone else)*
If accepted how soon are you looking to get started? (if you aren't ready please just wait and schedule when you can. I expect those who feel it's a fit to move forward. Those who don't take actions are 95% more likely to continue to do nothing).*

I will be available to take the call in a quiet, distraction free environment at our agreed upon time.*
Yes No
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Please Complete This Application