Initial Health Evaluation Form
Our Intentionally HIS community is 100% complimentary with lifetime access.
Your ONLY investment is the complete home workout program and nutrition bundle that is yours to keep forever that will give you all the steps you need to start and achieve your transformation. My focus is life long results and lifestyle CHANGES, so it's important that I get to know your needs, goals and preferences.
Fill out the form below and I'll make sure to get back to you in the next 24-72 hours with a recommendation, full details and your next steps! Glad to start this journey WITH you!
Email address *
Full Name *
Your answer
Phone Number *
Your answer
Best Email Address *
Your answer
Current Fitness level *
List any Beachbody Programs you currently own: *
Your answer
Have you ever tried Shakeology? *
Have you ever had a Beachbody coach before? *
Who referred you? *
What is your favorite workout style? (select all that apply) *
Required
What is your movement preference? *
How long would you like to workout each day? * *
On a scale from 1-10, how would you rate your current nutrition? *
What's wrong with Ice cream for breakfast?
I'm obsessed with nutrition!
What workout equipment do you currently have? (EX: Weights, Resistance Bands, Yoga Mat, Medicine Balls, treadmill, etc.) *
Your answer
Current Struggles You're Facing: *
Required
Do you have any injuries or limitations? *
Your answer
Are you: *
What are your short term (could achieve in 1 month) health goals? *
Your answer
What are your long term (could achieve in 1 year) health goals? *
Your answer
Describe your current workout & food routine and the results that you're getting. *
Your answer
What do you feel is stopping you from getting the results that you want? *
Your answer
When do you want to get started? *
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