First Name
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Last Name
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Email
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Are you a US, UK, or Canadian Citizen?
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US
UK
Canada
France
Others
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5 Are you currently working with a coach?
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A
Yes
B
No
Key
C
At one point I was, but am not currently
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Are you currently Expecting, Postpartum, or Planning to get pregnant in the next year?
Currently Expecting
Recently Postpartum
Planning to be Pregnant
NONE OF THE ABOVE
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IF Yes, Please indicate how far along you are/ or how many weeks PP you are.
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I am looking to?
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Improve my nutrition
Improve my overall strength/tone/cardiovascular/fitness
Improve both my fitness & nutrition
CHANGE MY LIFE by Creating Lasting Habits & Lifestyle!
Join the Fit-Fluencer Team + inspire others
Please share with me what most interested you in reaching out. What is your primary health & fitness goal? Please go into as much detail as you like. The more info I have the better I can help :)
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What would you say are currently your biggest obstacles/struggles?
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Working Out
Nutrition
Finding Time
Lacking Energy
Consistency
Motivation
Family Schedule
Not sure where to start or what to do?
Life with Little Ones
How would you describe your eating habits / meal planning? (i.e. bad habits, too picky, get lazy with food, default to fast food, love sweets etc.)
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Which one of these sounds most like you?
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A
B
Other
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When/ if you used to be active/fit on a regular basis, what were some of your favorite activities / what do you like?
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What have you tried before that has NOT worked for you? Have you ever tried home based workouts before, if so which ones?
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Where did you find me?
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Facebook
Instagram
Web Search
Friend/Family
Other
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PLEASE PROVIDE YOUR PHONE NUMBER I work with my clients 1:1 and often use text messages. I find it also helps us to coordinate our first call if we text directly. I NEVER SHARE THIS INFORMATION OR SPAM YOU WITH UNWANTED TEXTS.
I Do NOT charge for my coaching or access to my Wellness Academy or Wellness Studio. But, you DO need to invest in the program & program materials that we will be using inside the Wellness Studio. Below are options listed below, so please indicate which you feel is the best option for you.
ALL OPTIONS are ONE time expenses, and come with the following... an ANNUAL membership to my Online Virtual Wellness Studio & Academy, Library of over 3K STREAMING workouts, a nutrition guide, meal plan, weekly LIVE webinars with me, my customized workout calendars and E-Books, and ME as your coach. To complete your customized bundle select from the following options.
Everything above + Lifetime Access to my go to Meal Planning System AND complementary 30 Day Supply of Superfood Smoothies $200
Everything above + Lifetime Access to my go to Meal Planning System AND complementary 30 Day Supply of Proformance Supplements (Protein & Go-Go Mom Juice) $200
Everything above with 30 Day Supply of Superfood Smoothies, & access to Comprehensive Mindful Eating Nutrition Plan B (geared toward those who DO NOT WANT a restrictive meal plan, & are focused on health & developing a mindful relationship with food) $220
I already have access to the streaming library of workouts, so I just want the 30 Day Supply of Superfood Smoothies $129US
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If you have any other questions for me OR prefer a Bundle Option that is not listed PLEASE SPECIFY THAT HERE & I will customize your bundle.
If you selected a bundle option above please tell me what flavor Shakeology you would like or if you are interested in getting my "go-go mom juice" aka energize my all natural plant based pre workout. Vegan: Chocolate, Vanilla, Cafe Latte, Tropical Strawberry Regular: Chocolate, Vanilla, Cafe Latte, Strawberry, Greenberry
Are you interested in a preferred membership that qualifies you to save 25% & potentially earn cash back from referrals?
Yes
No
Would like more info
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