Glow Wellness Health Quiz

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I'm looking for 5 MOTIVATED women who are READY for a change, and ready to COMMIT to your health and happiness. I want to help you find your confidence and self-love again. No more fake smiles, hiding from pictures, and struggling to be nice to people. I'm going to help you feel amazing from the inside out. I want you to feel confident in your skin when you look in the mirror. I want you to love how your clothes fit. I even want you to love the way you feel when you're wearing nothing (or very little)!🥰

My online health and fitness community is free, and you have access for life once you enroll (hell yeah🙌🏻)! Your only investment is the NUTRITION PACK and HOME WORKOUT PLAN that are yours for an entire year (say whaaat😮) which give you all the tools you need to get started on your transformation and fitness journey. And I need you to know, this is seriously the BEST deal you will EVER get. If you let it, this will be the decision that changes your ENTIRE LIFE. This was the ONE decision that COMPLETELY changed mine, and I'm just so damn grateful😪💞

Remember this is a LIFESTYLE change. I am all about LONG-term physical and mental results, that are realistic and maintainable for YOU. So before we get started, I'd like to get to know a little bit more about you, your goals, and your current routine!

Please fill out the form below (no stress, I just want to help you specifically as best as I can :)) and I'll be sure to get back to you 24-72 hours with more details about my bootcamp group, and your next steps! Thank you SO much for putting your trust in me by choosing me to be your coach. I CANNOT wait to get to know you better and welcome you to our family!🎉👯‍♀️👭🎊

🙏🏻💞
Jacq

Email Address *

Name (First/Last) *

Phone number *

Instagram name *

Location *

USA

Canada

U.K.

Other:

Current Fitness Level *

Beginner

Intermediate

Advanced

Other:

How long would you like to workout each day? *

20-30 minutes

30-45 minutes

45-60+ minutes

Have you ever tried an online workout program before? *

Yes

Maybe

Are you already working with a coach?

Yes (explain in "other" box below)

Not right now, but I have before.

No and I never have.

Other:

Clear selection

Dig a little deeper

Let's talk about energy. How do you feel most days? *

Eh, I feel pretty lousy. I seem to have no energy and struggle to stay positive.

Mood swings are the norm. Both my energy and my moods are up, down, and all over the place.

I feel pretty high energy. I'm pretty well balanced and generally feel positive.

I always have amazingly high energy! I love life every day, and everything is totally awesome!

How much do you love your body? Scale of 1 (very little) - 5 (totally love) *

Tell me about your daily eating habits. Be as specific as possible. (Please include if you have any food allergies or are vegan/vegetarian etc.) *

Describe what you are currently doing for exercise and the results you are getting. *

What are your current fitness goals? *

What do you feel are your biggest obstacles for getting the results you want? *

Current struggles (check all that apply): *

Emotional eating

Losing weight

Accountability

Portion control

Commitment

Low energy

Time

Money

Not eating enough vegetables

Cravings

Self-discipline

All of the above!

Other:

Required

Do you have any injuries or physical limitations? *

What workout equipment do you have at home? (Resistance bands, dumbbells, mat, etc.) *

Anything else you'd like me to know?! *

And finally, the Most Important Question.

Option 1 should be the ONLY option. We can do this! You've made it this far, you're so ready! Are you as excited as I am!? Let's do this!

When are you ready to get started with changing your life? *

I'm SO ready right now!

I'm ready, but I have a few questions.

I want to, but I have to wait 'til next month.

Uncomfortable > happy! Can't wait to help you find your happy! 😊❣️

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