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First Name *
Last Name *
Birthday *
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DD
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Where exactly were you born? City, State, Country (if you're into astrology, gene keys & human design)
The exact time you were born. If you don't know, estimate. (if you're into astrology, gene keys & human design)
Email *
Phone *
Why did you reach out to me to help with your fitness? *
Where do you want your relationship with your body to be in 6-12 months? *
What are your biggest goals and why? (Be specific) *
What is preventing you from reaching these goals? *
Do you currently track your nutrition? *
How often do you exercise? *
Do you suffer from any of the following: *
Does my approach sound right for you? My program is based on helping you get fit, athletic, and heal from pain - mental, emotional & physical. We’ll focus on releasing unresolved traumas in your emotional body, creating new habits in your mental body, and create a strong, flexible, and fit physical body. *
Are you willing to invest in long term change? I will provide a clear plan of action to help you reach your goals, however, it may take a few months to get there. *
Are you willing to commit or decline my service when I call? *
When day(s) are you available for my phone call? *
What Time Zone do you live in? *
When is the best time to call you? *
Please add any additional information you feel is important for me to know. *
Where or how did you find me? *
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