Your FREE Personal Health Assessment
HI! This will help me know exactly what to recommend and how I can serve you BEST.

I know some of this stuff is hard to share. It's not easy being vulnerable but I am here to listen, support and serve.

My coaching to you is 100% FREE FREE FREE! I am reimbursed by the investment you make is in at home nutrition and/or fitness plan. That is totally your decision! My goal is to help with a long term solution that you can sustainstanily translate into every area of life. This assessment will help me find the perfect healthy formula FOR YOU!
Email address *
What is your name? *
Are you a Beachbody Coach?
Clear selection
Who is your Beachbody Coach? *(If you don't have one, you can leave blank!) *
Energy is EVERYTHING, tell me how you feel? *
Do you like to get physical? Tell me about your weekly physical activity! *
What kind of workouts do you typically enjoy? *
We all LOVE food. Tell me about your eating habits? *
Tell me what a typical day of eating looks like for you currently... *
Do you use an supplements? *
Do you drink or take anything for energy? (Coffee/caffeine) *
How is your stress life? how are you Handling it? *
Check all that apply *
Check any programs you have done? *
Do you have Beachbody On Demand Annual All Access Pass (Access to all of our programs for a year through our streaming site like Netflix for workouts)? *
Have you tried the 21 Day Fix container system? *
What were your results?
What about Shakeology? Answer with the one that best applies. *
How often do you eat out per week? *
Once a week
7+ times a week
How would you rate your healthy eating? *
Mcdonalds weekly
SUPER clean
What is your age range? *
Check all that may apply: *
How much do you love your body? (This isn't just an outward journey but inward journey too!) *
I struggle to look in the mirror
I LOVE IT! Super Happy with my body!
Why do you feel this way about your body? *
What do you struggle with the MOST when it comes to health, fitness and nutrition? *
What is your optimal goal for your health and fitness? Think SMART. (specific, measureable, achievable, realistic, timely) *
WHAT or WHO motivates you to live a healthy life? *
What is your reason for wanting to make a change now? Make this emotional and think past the surface! *
Scale of 1-10 how READY are you to make the change, feel incredible, enjoy the awesome support of the online community of women on your journey!? *
No thanks
I was BORN ready.
What are your expectations from me as your Coach and of our online accountability groups? (Amount of times you want me to check in, focus of the group, etc...) *
Anything else you want me to know about you? Questions or concerns? Make sure you check your email you provided in the next 24 hours for a response from me! *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.