Name *

First Name

Last Name

Phone *

(###)

###

####

Are you ready to commit to a sustainable solution?

Yes

No

Are you willing to communicate and engage in the process?

Yes

No

Would it be worth it to you if it took a full year to get there?

Yes

No

Do you have the resources to make a significant investment in your health?

Yes

No

Do you believe in the return on investment for improving your physical and mental well being

Yes

No

Do you believe that accomplishing your goals would improve other areas of your life outside of fitness?

Yes

No