JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Operation: #HotMomSummer Camp
Help me get to know a little about you and your goals!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your answer
If you're okay with text, enter your phone number.
Your answer
Name (first and last):
*
Your answer
Today's Date:
*
MM
/
DD
/
YYYY
When is your birthday?
*
Your answer
How did you find me?
*
Your answer
If you knew you would not fail, where would you ideally like to see yourself in 3 months? Think physically, emotionally, mentally, life goals, etc.
*
Your answer
Are you willing to invest in a fitness and nutrition program so that I may coach you to achieve your goals?
*
Your answer
What are your health & fitness struggles currently? Please be specific. (Address digestive health, energy level, any weight loss/gain goals, hormonal balance, pain, inflammation, etc.) The more details the better.
*
Your answer
How much time do you have to dedicate to exercise?
*
20 minutes
30 minutes
More than 30 minutes
Required
Please rate your energy level.
*
You can barely get out of bed.
1
2
3
4
5
6
7
8
9
10
You don't drink any stimulants and have vibrant energy all day.
Please rate your digestive health. 1- Poor 10- Flawless!
*
Poor
1
2
3
4
5
6
7
8
9
10
Flawless
Please rate your stress level
*
Unbearable. Constantly stressed.
1
2
3
4
5
6
7
8
9
10
You're on a beach relaxed.
Please rate your quality of sleep.
*
HORRIBLE. I get less than 5 hours of sleep/night.
1
2
3
4
5
6
7
8
9
10
Amazing! I sleep like a baby 8+ hours each night.
Please rate your level of confidence in yourself and your ability to be successful.
*
I don't believe I'll ever be successful.
1
2
3
4
5
6
7
8
9
10
I KNOW I will be as successful as I want to be. I feel it in my bones!
What are your biggest barriers to reaching your goals right now? Why have you not been successful in the past?
*
Your answer
Which Nutritional approach do you feel you'd benefit from more?
*
A program with more structure. You'd be told exactly how many portions of each food group to eat every day based on your goals and starting point. It would include training on the reasons why we crave certain foods, why we use the macronutrient breakdown we do and why portion control is important to be successful in your goals.
A program with more flexibility. With this approach, you could make it work even while traveling or eating at restaurants because you'll learn how to plate each meal. There are no food lists or counting involved. It is created especially for those who have a negative relationship with food such as emotional eating, stress eating, chronic dieters, or those who starve & binge. It's a shift in mindset more than anything. You'd learn how to say YES to the right foods instead of focusing on saying no to the wrong foods.
I'm not sure.
Do you currently have any food sensitivities? Do you have a plan or guide for your nutrition that you follow?
*
Your answer
Would you be interested in doing a 3-Day Cleanse to jump-start your metabolism and help banish belly bloat?
*
Yes
No
Maybe
Please check which fitness equipment you have at home.
*
Dumbbells
Aerobics step
Pull-up bar
Exercise or resistance bands
Yoga mat
Required
Are you interested in Energize (Plant-based pre-workout/energy booster)?
*
Yes - Lemon
Yes - Fruit Punch
Yes - Mixed Berry
No
Maybe
Are you interested in Recover (BCAA's formula to reduce muscle soreness and improve muscle building)?
Yes - Chocolate Whey
Yes - Orange Whey
Yes - Chocolate Plant-Based
Maybe
Clear selection
Are you interested in Bevvy? (A delicious tea to help crush cravings and chronic snacking)
*
Yes - Lemon
Yes - Pomegranate Berry
No
Maybe
Are you interested in Beachbars? (Our clean-eating Protein snack bars)
*
Yes - Chocolate Almond Crunch (my favorite)
Yes - Chocolate Peanut Butter
Yes - Chocolate Cherry Almond
No
Maybe
Are you interested in Collagen scientifically proven to improve skin, nails + hair in just 30 days?
*
Yes
No
Maybe
I usually recommend my clients' start with a powerful foundational supplement called Shakeology. It is an incredibly nutrient-dense formula that supports the body in several capacities with over 70 superfoods per serving. What flavor of Shakeology would you like to try first? There is a vegan option best for those with digestive sensitivities.
Vanilla Vegan
Vanilla
Chocolate Vegan
Chocolate
Strawberry Vegan
Strawberry
Cafe Latte Vegan
Cafe Latte
Clear selection
Are you interested in a VIP Client membership? (You can register for FREE to get all your supplements/goods at wholesale cost with a $15.95 monthly membership fee. Think Costco with big savings!)
*
Yes
No
Maybe
Are you interested in joining our team of health accountability coaches and building a business of your own? *This can be as part-time or full-time as you'd like. We have everything set up for you to help you be successful! Our team is in the top 5% of the company. We know how to make anyone successful whose willing to learn!
*
Yes
No
Maybe
Where is your home residence?
*
US
UK
Canada
France
Required
Anything else you would like to add about your situation?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
