Empowered By Strength-Your 12 Week Strength & Intuitive Eating Program (OCTOBER)

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Congrats! You have made it one step closer to achieving your wellness goals! I have put together a short questionnaire for you to fill out before we get started. You will hear back from me within 24 hours of submitting your application.We start the weekend of April 17th

First & Last Name *

Age

Where do you live

Email *

Have you ever worked with a health coach or personal trainer before?

Yes

Clear selection

Which of the best applies to you?

I am looking for fat loss and to feel good

I want to feel confident and stronger

I've tried everything and want a change NOW

I kind of know what I need to do but struggle to stay consistent

Clear selection

What symptoms are you currently experiencing if any? Examples: bloating, always tired, etc

Describe your current "diet"

I eat whatever I want

I'm on a diet

I have an inconsistent routine

I eat pretty healthy

Clear selection

How often do you workout?

Never/Rarely

1-2 days per week

3-4 days per week

5+ days per week

Clear selection

How much money are you willing to invest in yourself to learn tactical and life transformative skills so you can finally ditch dieting and all the bullshit fads that aren't get you anywhere but frustrated?

Under $500

$500-$1000

$1000-$1500

Almost anything

Clear selection

Submit

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