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Tafiq's Metabolic Pre-Screening Application

Please fill out each section honestly and with complete detail. 

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Question 1 of 20

Name?

Question 2 of 20

Email?

Question 3 of 20

Mobile Phone?

Question 4 of 20

Age?

Question 5 of 20

Favorite show you've watched during quarantine?

Question 6 of 20

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 20

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

Question 8 of 20

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

Question 9 of 20

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

Question 10 of 20

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 11 of 20

If yes, please explain (in detail)

Question 12 of 20

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 13 of 20

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

A

Yes

B

No

Question 14 of 20

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

A

$669 - $999

B

$399 - $699

C

$1299 - $1599

D

$999 - $1299

E

$1899 - $2199

F

$1599 - $1899

Question 15 of 20

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

A

Yes

B

No

Question 16 of 20

If yes, how did you like the experience?

Question 17 of 20

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 18 of 20

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

Question 19 of 20

What do you do for a living?

Question 20 of 20

Why Should I consider you for the Metabolic Makeover Program?

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