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Tafiq's Metabolic Screening Application

Please fill out each section honestly and with complete detail. 

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Question 1 of 23

Name?

Question 2 of 23

Email?

Question 3 of 23

Mobile Phone?

Question 4 of 23

Age?

Question 5 of 23

Favorite show you've watched during quarantine?

Question 6 of 23

What is the number one health and fitness goal you’d like to achieve in the next 3 months?

Question 7 of 23

With your job, are you primarily...

A

Sedentary

B

Active

C

I do not work and I'm pretty sedentary

D

I do not work but I'm pretty active

Question 8 of 23

What do you do for a living?

Question 9 of 23

What is the main thing that brings joy to your life?

Question 10 of 23

If you could eat one food with no negative health effects for the rest of your life what would it be?

Question 11 of 23

Are you currently suffering from any hormone or metabolic imbalances that you are aware of (i.e. adrenal, thyroid, digestive disorders, menopause, andropause, pituitary, etc…)? 

A

Yes

B

No

C

Not sure

Question 12 of 23

If yes, please explain (in detail)

Question 13 of 23

Are you willing to commit to working out for at least 30 minutes 3 times per week to reach your goal?

A

Yes

B

No

Question 14 of 23

Are you willing to commit to changing the way you eat to reach your goals?

A

Yes

B

No

Question 15 of 23

Are you married or have a significant other? If so, how long have you been together?

Question 16 of 23

Will you need to confer with your spouse or significant other prior to signing up for the program?

A

Yes

B

No

Question 17 of 23

What are you willing to invest in to a customized coaching program to achieve your health and wellness goals?  

A

$669 - $999

B

$2199 - $2499

C

$1299 - $1599

D

$999 - $1299

E

$1899 - $2199

F

$1599 - $1899

Question 18 of 23

Have you invested in your health and fitness in the past?

A

Yes

B

No

Question 19 of 23

If yes, how did you like the experience?

Question 20 of 23

Do you have children? If so, how many and what are their ages?

Question 21 of 23

On a scale from 1-10, 10 being "I'M READY LET'S DO THIS". How ready are you to commit to transforming your health?

Question 22 of 23

 If you are not at a 10, what would it take to get you to a 10?

Question 23 of 23

Why Should I consider you for the Metabolic Makeover Program?

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