Healthy Habits Online Group Reservation
The goal of joining this Healthy Habits group is to create and solidify the healthy habits YOU want for yourself.

In this group, we're focusing on three main areas and you have the option to participate in 1, 2 or all 3 with us! The healthy habits we'll be helping you with are: 

1. Nutrition / Meal Plan / Meal Prep
2. Exercise & Fitness 
3. Health & Performance Enhancements (to Expedite your Results)

Filling out this form will help me guide you to the right fitness and/or nutrition options for you.

Your investment in your results is up to you. My job is to help get you to your desired goal.
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First Name *
Last Name *
Email *
Phone number (optional)
What are your HEALTH goals? Check all that apply *
Required
What are your FITNESS goals? Check all that apply *
Required
What are your WELLNESS goals? Check all that apply *
Required
If you were to reach your goals, how would that make you FEEL? *
How long have you been struggling with this? *
Do you have a date in mind by which you want to achieve this? *
What can't you do now, that you want to be able to do? (ie: keep up with your kids, fit into your clothes, go up a flight of stairs) *
What have you tried in the past that didn't work? *
Why do you think it didn't work for you? *
Are you currently taking medications that could be avoided with improved diet and/or exercise? *
How often do you eat out? (fast food, coffees, restaurants, etc) *
How often do you exercise? *
When you do exercise, how long do you exercise? *
At what intensity do you exercise on a scale of 1-10 *
= barely moving
= can't possibly do any more
What kinds of workouts do you enjoy, or have enjoyed in the past? Check all that apply *
Required
After going through this survey, tell me which Healthy Habits you want to focus on (Check all that apply) *
Required
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