5-Day Free Coaching Experience Application

✨ Thank you for your interest! This free 5-day coaching experience is designed to give you daily support, new tools, and breakthroughs to help you lose weight, boost your energy, and feel more confident. To make sure you get the most out of it, please answer a few quick questions below.

About You

Full Name *

Email *

Phone *

Date of birth *

Lifestyle & Work

It’s important for me to understand how much movement you do each day, so please indicate how many hours you work in a typical week. *

0-10 hours

11-30 hours

31+ hours

What is your current job role? *

e.g. Doctor, secretary, unemployed

Thinking about your current lifestyle, do you feel you’ll have enough time to focus on yourself and commit to this 5-day experience? *

Yes, definitely

Somewhat, but it’s a challenge

Not really

Your Goals

What are the top 3 things you’d love to achieve in the next 3–6 months? *

What do you feel is holding you back right now from reaching your health goals? *

On a scale of 1–10, how motivated are you to make a change right now? *

1–3 = Not very motivated

4–6 = Somewhat motivated

7–10 = Very motivated

Commitment & Investment

If this free experience gives you the results and confidence you’re looking for, how likely are you to continue with ongoing support/coaching to reach your bigger goals? *

Very likely

Not right now

Do you currently invest in yourself when it comes to your health and fitness (e.g. gym, classes, meal services, coaching)? *

Yes, regularly

Sometimes

Not at the moment

If you found the right program that was guaranteed to help you achieve all of your goals would be willing to financially invest? *

Yes