Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please describe your current mindset *

Please check all that apply

I often feel guilty for not being healthier

I am overwhelmed by diet advice

I don't know where to begin with incorporating fitness

I don't know where to begin with nutrition/food prep

I often feel discouraged about my body

I often feel low energy

I prioritize everyone else's needs above my own

I am ready to take control of my life

I want to feel confident and empowered when it comes to my health

Please describe your current fitness *

Please check all that apply

I workout regularly

I love to lift weights

I am not in a good routine with fitness

I am too busy to fit in fitness regularly

I don't know how to lift weights - I am intimidated by this

I love to exercise outdoors, but when the weather is bad, I tend to be sendentary

Please describe your current nutrition *

Please check all that apply

I eat breakfast daily

I drink at least 64 oz water daily

I eat veggies at at least 2 meals/day

I track my calories/macros

I get protein at most meals

I eat healthy complex carbs a few times per day

I am hungry often

I am hardly ever hungry

I have a complicated relationship with food

Please describe your current social / emotional health

Please check all that apply

I feel well connected in my community and I feel like I have a good support system

I often feel lonely or wish I had more fun things to do on my calendar

I have a good group of friends and have a full social calendar

I realize I need to find some new friends - women who have similar values and who encourage me to be a better me

I am self-aware and have done a lot of personal development

I feel like I don't really know who I am and who I want to be when I grow up

For our 1:1 Calls every other week, please choose a day/time that works best for you. *

You can choose more than one option, and if none works, please indicate in the other field.

Tues midday

Tues early evening

Wed midday

Wed evening

Thurs midday

Thurs early evening

Thurs evening