Health & Fitness Program Application
Help me get to know a little about you and your goals!
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Email *
Name: (first and last) *
Phone *
Today's Date *
How did you find me? *
What are your 3 biggest struggles currently  in your wellness journey?
What are your top 3 goals you want to establish for these next 30 days? List a goal from each of the 3 categories. Please share as much detail as possible. Examples are only shared as examples, it could be whatever is the highest priority for you.
1- Physical goal: (Ex: weight loss goal, strength goal, size, toning, improve digestion, etc)
2- Mental/Emotional goal: (Ex:reduce anxiety, improve motivation, improve depression, improved stress management, etc)
3- Functional Goal: (Ex:Meal prep, have a solid morning routine, time management, etc...)
Why are the above goals important to you? What is the cost if you don't make a change?
Which Nutritional approach do you feel you'd benefit from more? *
Do you have any digestive sensitivities and/or food intolerance's to dairy, gluten, etc?
Please check which fitness equipment you have at home *
The following questions are about supplements and products that may benefit you.
I usually recommend my clients' start with a powerful foundational supplement called Shakeology. It is an incredibly nutrient dense formula that supports the body in several capacities with over 70 superfoods per serving. What flavor of Shakeology would you like to try first? (Flavors are Vanilla, chocolate, strawberry, cafe latte -OR- Vegan flavors-  Chocolate, vanilla, cookies & creamy, tropical strawberry, & cafe latte) *
Would you be interested in doing a 3-Day Cleanse to jump start your metabolism and help banish belly bloat? *
Are you interested in my "Morning Muscle Margarita" concoction to boost motivation + energy? (Consists of Energize, collagen, + Hydrate)
Are you interested in Recover (BCAA's formula to reduce muscle soreness and improve muscle building) *
Are you interested in Beachbars? (Our clean-eating Protein snack bars, certified GF, Vegan oprtion, low glycemic-index, good fiber source, all clean ingredients)
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Are you interested in First Thing? It is a morning health shot with 4 formulas combined in one to support brain function, immune health, energy, and stress support.
Are you interested in a sleep support supplement called Last Thing?
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Are you interested in a preferred customer 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!) *
Are you or your spouse active duty military or veteran? *
Are you interested in learning more about becoming a coach yourself or joining our team ambassador program? *
Anything else you would like to add about your situation?
A copy of your responses will be emailed to the address you provided.
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