2018 Slim Down Group Application
Please answer the following questions to the best of your ability. Your answers will help Stacey James determine your needs for healthy weight loss
First Name *
Your answer
Last Name *
Your answer
Email address: *
Your answer
Alternate Contact Method *
(Select ALL that apply. You will not be spammed)
Required
Alternate Contact Method Details *
Provide phone number for phone call or text message, Facebook page link, alternate email address, best time to reach you, etc. If it doesn't apply, type N/A.
Your answer
Age *
Your answer
Weight *
If you are not sure, provide your best guess.
Your answer
Height *
Feet and inches. For example, 5'6"
Your answer
What are your health/weight loss/fitness goals? *
Select all that apply
Required
Why do you want to be part of the 2018 Slim Down group? *
The more information you provide, the better I can help you.
Your answer
What is your weight/health/fitness history? *
How long have you struggled with weight loss? What are some of the things you've tried for weight loss? How did they work our for you? If you've been at your goal weight or fitness level, when was that and what were you doing differently?
Your answer
In the last 2-3 years, about how much have you spent on health/weight loss/fitness programs or products? *
Includes vitamins or pills, weight loss center fees, meal services, gym membership, home fitness programs, weights or exercise machines, personal trainer, boot camps, surgery, etc. For example, "$500 in the last year," "$75 per month," "$3500 in the last 2 years," etc.
Your answer
How many days a week do you work out? *
What type of workouts or workout program do you do? *
Your answer
What are your nutrition & eating habits like? *
Your answer
What is the biggest obstacle that prevents you from achieving your weight loss/health/fitness goals? *
Select all that apply
Required
Have you heard of Shakeology? *
On a scale of 1-10 with 10 being the highest, how serious are you about improving or achieving your health/weight loss/fitness goals? *
Do you currently have a Team Beachbody Coach? *
If you answered "Yes" to the question above about having a Team Beachbody Coach already, are you currently, actively working with them? *
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