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Preparation for appointment

Please fill out this form so I can be prepared for our appointment

Without an application form from you, your appointment will be cancelled

It has been designed to figure out if this program is the right fit for you.

Click the button below to start.

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Question 1 of 14

What is your first and last name?

Question 2 of 14

What is your email AND phone number (including country and area code)?

Question 3 of 14

How did you hear about me and my 12 Week Program?

Question 4 of 14

Please select your call preference:

A

Zoom

B

Phone

Question 5 of 14

Which age bracket are you in?

A

20-34

B

35-44

C

45-54

D

55-64

E

65 +

Question 6 of 14

What is your current biggest frustration with your body and/or health?

Question 7 of 14

What are you hoping to achieve with your health and/or body?

Question 8 of 14

What do you think is your biggest obstacle to you achieving this goal?

Question 9 of 14

Briefly describe your current lifestyle: ie work hours, family life, any stresses, current nutrition and drinking habits, current exercise if any.

Question 10 of 14

Right now I....

A

Have the financial resources to invest in myself and my long term weight goals, energy and health

B

Have access to the financial resources to invest in myself and my long term weight goals, energy and health

C

I don't have any financial resources at all, and I'm going to have to keep working on my health and weight loss as is.

Question 11 of 14

If someone advised me to spend $1,000-2,000 on a coaching program to help me achieve my weight loss goals, gain energy and body confidence, I would...

A

Know it's what any serious and committed woman needs to do to move forwards.

B

Be a little cautious, yet with a proven system I would do it because I'm serious about my health.

C

Avoid at all costs, because I need/want to do things as cheaply as possible.

Question 12 of 14

I believe working with a qualified and experienced health practitioner is a worthwhile investment.

A

Yes

B

No

Question 13 of 14

I will call you at the time you chose. Please commit to your appointment time by typing this sentence in the box below: "Yes, I promise I will answer the phone/zoom for my health strategy appointment".

Question 14 of 14

Finally, what's the single most awesome thing about YOU?

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