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Metabolic Makeover Screening Application

Please fill out each section honestly and with complete detail. 

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Question 1 of 22

Name?

Question 2 of 22

Email?

Question 3 of 22

Mobile Phone?

Question 4 of 22

Age?

Question 5 of 22

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

Question 6 of 22

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

Question 7 of 22

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 22

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

Question 9 of 22

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 10 of 22

If yes, please explain (in detail)

Question 11 of 22

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

A

Yes

B

No

Question 12 of 22

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

Question 13 of 22

Will he/she be supportive of your health and fitness coaching journey?

A

Yes

B

No

Question 14 of 22

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 15 of 22

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

A

Yes

B

No

Question 16 of 22

If yes, how did you like the experience?

Question 17 of 22

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

Question 18 of 22

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 19 of 22

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

Question 20 of 22

Will you commit to a year of coaching to achieve lasting results?

A

Yes

B

No

Question 21 of 22

Will you commit to providing video testimonials quarterly to share your experience coaching with Tafiq?

A

Yes, Absolutely!

B

No, I will not

Question 22 of 22

Why Should I consider you for my custom coaching program?

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