Application - Weight Loss Coaching
Please complete this short form so I can get to know you better.

After you complete the form, I'll reach out to you to schedule a 30-minute weight loss breakthrough session where we'll discuss your goals in more details.
Name *
Your answer
Phone *
Your answer
Email *
Your answer
Age *
Your answer
How much weight do you have to lose? *
What have you tried in the past and what results did you get? *
Your answer
What obstacles or challenges are preventing you from losing the weight? *
Your answer
How does being overweight limit your life? What activities or opportunities are you missing out on? *
Your answer
What do you think it is costing you financially every month NOT to feel healthy, fit and confident in your body? What do you think are the total costs of all the opportunities, raises, clients, and business you’re missing out on? Be sure to include missed opportunities as well as medical and cosmetic costs. *
How committed are you to getting help now so you can finally lose the excess weight? (note: this has nothing to do with my program - this is your personal commitment to change your situation) On a scale of 1 to 10 with 10 being super committed: *
Not Committed
Super Committed
What do you REALLY want to achieve going through coaching? *
Your answer
Are you willing to do the work necessary to get to the other side, EVEN if it gets uncomfortable at times? *
On a scale of 1-10: 10 being a life you LOVE, feeling amazing; 1 being miserable and barely surviving each day….Where are you right now? *
What awesome things would happen if you finally lost the weight and felt 10/10 amazing? *
Your answer
What motivated you to schedule this call? *
Your answer
Have you watched my free weight loss training? If you have not, I highly recommend you do before our call: *
Is there anyone else who needs to be on the call in order for you to make a financial decision? If yes, please ensure that person is on the call with you. *
Do you promise to show up for your call free of distractions, NOT driving, at the store etc.? If you cannot make your time PLEASE reschedule in advance. *
Is there anything else you feel it’s important for me to know? *
Your answer
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