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MYOFIBER - Initial Intake Screener
Please fill this out to determine your eligibility for our coaching program(s).
After completion of this form, you will be contacted within 2 days.
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* Indicates required question
Email
*
Your email
Name:
*
Your answer
Telephone#:
*
Your answer
Did anyone refer you to this application form? If yes, who?
*
No
Other:
What are you current health and fitness goals?
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Your answer
How much progress have you made in trying to achieve your current goal(s)?
*
Your answer
Why do you want to achieve this/these goal(s)?
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Your answer
What is the biggest problem preventing you from achieving your goal(s)?
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Your answer
On a scale of 1-10, how motivated are you in changing your lifestyle to achieve your goals?
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Not motivated at all
1
2
3
4
5
6
7
8
9
10
SUPER EXCITED, I'LL DO ANYTHING
How much $ are you willing to invest in yourself and your health on a monthly basis?
*
$99-$249
$250-$399
$400+
Send me a copy of my responses.
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