Name
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First
Last
Best Email
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Phone Number
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What is your current occupation?
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What is your age?
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What is your height in inches? (For example 5 feet 4 inches=64)
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What is your current weight
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What do you believe is your ideal weight?
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When was the last time you weighed your ideal weight, in total years? (for example if it was 25 years ago since weighing your ideal weight you would type 25 in the box)
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How many weight loss strategies have you tried in the past to lose weight?
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1-5
6-10
too many to count
What are the top 3 struggles you have due to your current weight?
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If you could wave your hand and immediately be at your ideal weight, how would your life be different?
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How soon are you committed to beginning your journey to reach your ideal weight?
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RIGHT NOW - I want to get started immediately.
WITHIN 90 DAYS - I have other things to attend to first.
MORE THAN 90 DAYS - I want to lose weight eventually but I'm not sure when.
This is a Real Coaching Call - Please Confirm Your Commitment On this call, we're going to dig into your weight loss struggle and walk you through exactly what it takes to reach your ideal weight. By selecting YES below, you confirm: 1-You'll be in a quiet, private place where you can focus (no driving, no distractions, no multitasking - we take your safety and this conversation seriously) 2-You're serious about finally solving your weight problem
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YES - I commit to showing up fully present and ready for a real coaching conversation
NO - I'm not ready to commit seriously to solving my weight problem
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