Step into the next chapter of your health and strength journey, fill out this quick application form.

First Name *

Last Name *

Email *

Phone *

What goals would you like to achieve? *

Weight Loss

Tone Up

Increase Energy

All the Above

Why are achieving these fitness goals important to you? *

What is the biggest obstacles preventing you from reaching your goals?

No time / Busy schedule

Unhealthy Eating Habits

Lack of Consistency & Motivation

Don't know where/how to start

Hormone Changes

Have you previously tried to lose weight? *

Yes

No

If yes, please describe what you have tried previously. *

What you do for work plays a huge a roll in your daily activity and your overall health and fitness. What is your occupation? *

Every busy woman over 40 I have worked with had a moment/ breaking point where they decided enough is enough, and it was time to make a lifestyle change. What was that moment for you? *

On a scale of 1 - 10, how serious are you in making a healthy lifestyle change to achieve your weight loss goals?

110

How did you hear about my HealthE Lifestyle Coaching Program that helps Busy Women over 40 keep Nutrition and Weight Loss SIMPLE? *

Instagram

Facebook

Referral

If Instagram, what's your IG profile? If Facebook, what's your FB profile? *

Example: @ericmyles_

The HealthE Lifestyle Coaching Program is a premium Weight Loss program that guarantees results. What would you be willing to invest to become the happiest and healthiest version of yourself? *

Finances aren't an issue, I'm ready to go ALL-IN!

I have a budget but if the program guarantees results, I'm in!

I have less than $500 to spend

Are you willing to make at least a 6-month commitment to achieve your goals? *

Yes

No

If your application is approved, you and I will hop on a 45- 60 minute zoom call. Are you the final Decision Maker, in regard to investing into the program? If No, please have your spouse/ partner on the call with you. *

What is your sex? *

Male

Female

Other

What is your age? *

Do you have any other questions or want to tell me anything else about you? *

Step into the next chapter of your health and strength journey, fill out this quick application form.

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