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

First Name *

Last Name *

Email *

Phone *

What are your fitness goals? *

Weight Loss

Tone Up

Increase Energy

All the Above

Why is achieving these fitness goals important to you? *

What is the biggest obstacle preventing you from reaching your fitness goals?

No time / Busy schedule

Unhealthy Eating Habits

Lack of Exercise

Don't know where/how to start

Have you previously tried to lose weight? *

Yes

No

If yes, what have you tried? *

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/ mom 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 health and weight loss goals?

110

How long have you been following me (Coach E)? *

Less than 3 months

3 - 6 months

6 - 12 months

Over a year

How did you hear about my HealthE Lifestyle Coaching Program for Busy Moms that helps keep Nutrition and Weight Loss SIMPLE *

Instagram

Facebook

Referral

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

Example: @ericmyles_

What in particular stands out to you about my coaching program? *

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 4-month commitment to achieve your goals? *

Yes

No

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

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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