Free Health & Fitness Questionnaire
Name
*
First Name
Last Name
E-mail
*
example@example.com
Do you like to get physical? Tell me about your weekly physical activity:
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Very little movement each day other than normal daily activities (no physically demanding job either).
I have a physically demanding job, but do not add extra working out on top of that.
Work in progress. I make a conscious effort to workout 1-2 times a week.
I have a physically demanding job, but add on workouts when I can. (ex.: Nurse working 12 hour shifts)
Fitness is on my mind. I try to workout 3-5 times per week.
Working out is a priority to me. I do a legitimate workout once a day at least 5-6 days per week.
Love my workouts. Some call me obsessed. I call it dedication! It's my form of therapy!
Tell me where/how you're struggling with your fitness? Are you looking to lose weight, tone up, build strength, etc?
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For the love of food, tell me about your current eating habits (No judgment! Keeping it real!):
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I eat clean - If it's processed, it's not getting this body
I eat generally pretty well, but fall off the wagon every now and then and have to get back on.
I have an awareness of health eating and a make a conscious effort, but late night ice cream or potato chips are kind of my jam.
Fast food, sodas, and packages snacks are no stranger to me.
Tell me what a typical day of eating looks like for you OR tell me if this is something you would like to improve and why! No judgement!
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What is your budget? (select as many as needed)
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Free 14 day trial
$40
$99
$120 - $160
$200 - $240
How can I pray for you?
Any other information you would like for me to know about? (I'll be in touch soon! Be sure to check the email you provided. I can't wait to get to know you more!)
*
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