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Step
1
of
5
20%
Do you currently have a health or weight goal?
*
Yes
No
Why do you want to make this change?
*
Sorry, but this opportunity is only available to people who have a health or weight goal.>
How will your life be different when you make this change?
*
Why is now the time to take this on?
*
With my help, how confident do you feel that you can reach your goal?
*
(1 being “It’s impossible”, 5 being “I believe there’s a way”, 10 being “No doubt I will do it”)
Please enter a number less than or equal to
10
.
Why do you think I am the right person to help you?
*
Are you ready and willing to commit to the process and do what it takes to make it happen?
*
What is your full name?
First
Last
What is your age?
*
What is your best email address?
*
What is your best phone number?
*
How did you find me?
*
Is there anything else you think I should know?
If your application is approved, the next step is to schedule a call with me to discuss your health and weight journey. Are you committed to showing up to the call?
*
Yes
No
If we agree that the program is the path to your success, are you prepared to make an initial $500 deposit on the call to secure your spot?
*
I am willing and able to invest in my weight loss journey.
Even if I wanted to, I wouldn't have that kind of money.
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