check

Metabolic Health & Vitality Pre-Screening Application

Please fill out each section honestly and with complete detail. 

Click the button below to start.

Start

Question 1 of 24

Name?

Question 2 of 24

Email?

Question 3 of 24

Mobile Phone?

Question 4 of 24

Age?

Question 5 of 24

Your biggest health and fitness challenge? (please explain in detail)

Question 6 of 24

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 7 of 24

Are you willing to follow the nutrition, fitness, and lifestyle recommendations of a coach to overcome those challenges (including daily physical activity, food journaling, and consuming mostly home-cooked meals)?

A

Yes

B

No

Question 8 of 24

Are you open to doing online workouts?

A

Yes

B

No

Question 9 of 24

Do you own dumbbells or any other exercise equipment? (please list all)

Question 10 of 24

Are you currently suffering from any hormone or metabolic imbalances that you are aware of (i.e. adrenal fatigue, thyroid imbalance, digestive disorders, menopause (women), andropause (men), pituitary issues, liver problems, or any other )? 

A

Yes

B

No

C

Not sure

Question 11 of 24

If yes, please explain (in detail)

Question 12 of 24

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

A

Yes

B

No

Question 13 of 24

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

Question 14 of 24

Will he/she be supportive of you working with a coach to reach your health and fitness goals?

A

Yes

B

No

Question 15 of 24

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

Question 16 of 24

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

A

Yes

B

No

Question 17 of 24

If yes, what did you like most about the experience?

Question 18 of 24

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

A

$399 - $699

B

$999 - $1299

C

$1299 - $1599

D

$99 - $399

E

$699 - $999

Question 19 of 24

Do you consider yourself to be overweight?

A

Yes, I'm a little overweight (need to lose 10 to 15 pounds)

B

Yes, I'm overweight (need to lose 20-30 pounds)

C

Yes, I'm very overweight (need to lose 40 or more pounds)

D

No, I'm not overweight I need to improve my overall health and fitness.

Question 20 of 24

Some health and fitness issues take more time to heal and strengthen. If needed, would you commit to a program for 6 months or longer to achieve your desired health and fitness results?

A

Yes

B

No

Question 21 of 24

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 24

 If you are not at a 10, what is stopping you from being at a 10?

Question 23 of 24

How did you hear about me?

Question 24 of 24

Why Should I consider you for my custom coaching program?

Confirm and Submit