Virtual Wellness Community Application
Welcome and thank you for showing interest in my Virtual Wellness Community! Fill out the information below so I can figure out the best plan of action for you.
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Email *
What is your full name? *
What is your Instagram handle? (If you do not have one please write N/A) *
What country do you live in? *
Are you currently a coach or working with another coach? *
What GOALS do you have your your health and wellness if nothing was holding you back for the next year? *
What are your current health and wellness struggles currently? (I want to know about your digestive health, energy levels, weigh loss/gains, pain, inflammation, motivation, etc.) *
Please rate your energy levels: (1 = you can't get out of bed. 10 = thriving energy all day *
Can't get out of bed
Please rate your level of confidence and ability to be successful: (1 = I don't believe I will ever be successful. 10 = I know I will be successful. I have zero doubt) *
I don't believe I will ever be successful
I know I will be successful
What are your biggest barriers to reaching your goals? Why have you not been successful? *
Give me a glimpse into your nutrition in a day! What do you eat? When and how much? Are you a stress eater? Chronic dieter? Do you feel guilty when you splurge? How is your self-control? *
Which nutrition program do you feel like you would benefit more from? *
What is your current fitness level? *
What flavor or my superfood shake interests you the most? (Check all that apply) *
Would you be interested in doing a 3-Day Cleanse to jump start your metabolism and help banish belly bloat? *
Are you interested in a plant based pre-workout/energy booster? (Check all that apply) *
Are you interested in a post-workout recovery formula designed to help reduce muscle soreness and help with results? (Check all that apply) *
Are you interested in a clean-eating protein snack bar? (Check all that apply) *
Are you interested in joining our team of coaches and building a business of your own? (This can be as part-time or as full-time as you would like. We have everything set up for you to help you succeed if you are willing to learn!) *
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