Join Jessica's Next Health & Fitness Challenge!
Help me get to know a little about you and your goals!
Email address *
Phone *
Your answer
When is your birthday? *
Your answer
Name: (first and last) *
Your answer
if you knew you would not fail, where would you ideally like to see yourself in 3 months?
Your answer
Are you willing to invest in a fitness and nutrition program so that I may coach you towards achieve your goals? *
Your answer
What are your health & fitness struggles currently? Please be specific. (Address digestive health, energy level, any weight loss/gain goals, hormonal balance, pain, inflammation, etc) *
Your answer
What are your biggest barriers to reaching your goals right now? Why have you not been successful in the past? *
Your answer
Give me a glimpse into your nutritional habits. Have you ever struggled with being an emotional/stress eater? Are you a chronic dieter? Do you feel guilty when you splurge? Do you have good self control when it comes to junk food/sweets? Any specific cravings? *
Your answer
What is your current fitness level-- beginner, intermediate or advanced? *
Your answer
Are you interested in Energize (Preworkout) or Recover (Post workout)? *
Are you interested in Beachbars? (Our clean-eating Protein snack bars)
What flavor of Shakeology would you like to try first? (This is what I refer to as "magical powder". It is incredibly nutrient dense and supports the body in several capacities with over 70 superfoods per serving. Flavors are Vanilla, chocolate, strawberry, cafe latte, greenberry -OR- Vegan flavors- Best for those with digestive sensitivities: Chocolate, vanilla, tropical strawberry, & cafe latte) *
Your answer
Are you interested in a wholesale membership? (You can register for FREE to get all your supplements/goods at wholesale cost with a $15.95 monthly membership fee. Think Costco! Big savings!) *
Anything else you would like to add about your situation?
Your answer
If you would like to be considered as a participant of my next health & fitness challenge group, comment "YES" below, and I will email information about the group within 48 hours of your application. *
Your answer
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