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Question 1 of 11
Which one is holding you back the most from achieving your personal goal(s)?
A Negative Mindset (I.e Fall victim to your excuses etc...)
Lack of Exercise Routine
Question 2 of 11
How much weight do you want to lose?
5 to 15lbs
15 to 25lbs
25 to 35lbs
35lbs and more
Question 3 of 11
How does it make you feel at your current weight?
Question 4 of 11
When was the last time you felt great (i.e. Before having children, get married etc…)?
Question 5 of 11
What other program(s) (i.e. Gym Membership, Personal Trainer, Weight Watchers etc…) have you done in the past?
Question 6 of 11
What do you think is holding you back?
Question 7 of 11
What does your dream body and healthy lifestyle look like?
Question 8 of 11
How is your current health and/or lack of a healthy lifestyle affecting your relationships (i.e. Spouse, kids, social etc…)?
Question 9 of 11
How important is it for you on a scale of 1 - 10 to make the changes needed?
1 (Not important)
2 to 4 (Some what important)
5 to 6 (Important)
7 to 9 (Very Important)
10 (Extremely Important)
Question 10 of 11
On average, how much have you invested monthly to achieve your weight loss goals in the past?
Between $50 - $100
$100 and Up
Question 11 of 11
Please provide your:
Best Time To Contact You
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