Health Assessment
Fill out my health assessment below, so together we can get you started on a health & fitness journey that's right for YOU!
Full Name
*
First Name
Last Name
Email
*
example@example.com
Country
*
United States
United Kingdom
Canada
Are you currently a coach or working with a coach?
*
Yes
No
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, bloating etc.)
Please rate your energy levels:(1 - you can't get out of bed. 10 - thriving energy all day.)
*
1
2
3
4
5
6
7
8
9
10
Please rate your digestive health:(1 - Poor. 10 - Amazing.)
*
1
2
3
4
5
6
7
8
9
10
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.)
*
1
2
3
4
5
6
7
8
9
10
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?
*
Which nutrition approach do you feel like you'd benefit from more?
*
A program with more structure. You'd be told exactly how many portions of each food group to eat every day based on your goals and starting point.
A program with more flexibility. With this approach, you could make it work even while traveling or eating at restaurants focusing on balance.
I honestly don't know.
What is your current fitness level?
*
Beginner
Intermediate
Advanced
What flavor of my superfood veggie shake interests you most?
*
Vanilla
Chocolate
Strawberry
Cafe Latte
Would you be interested in doing a 3-Day Cleanse to jump start your metabolism and help banish belly bloat?
*
Yes
No
Maybe
Are you interested in a plant based pre-workout/energy booster?
*
Yes - Lemon
Yes - Fruit Punch
No
Maybe
Are you interested in a post workout recovery formula designed to help with results?
*
Yes - Chocolate
Yes - Orange Creamsicle
No
Maybe
Are you interested in a clean-eating Protein snack bars?
*
Yes - Chocolate Peanut Butter
Yes - Chocolate Cherry Almond
No
Maybe
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! Our team is one of the top and highest ranked in the company! We know how to make anyone successful whose WILLING to learn!
*
Yes
No
Maybe
Submit
Should be Empty: