Application
Thank you for your interest! You've taken the first step in your journey.  Please complete the form below to see if we’re a good fit.
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Name: *
Email: *
Phone Number *
How did you hear about Bonnie Lefrak and the Self Made program? *
Age *
What is your current weight and height? *
What is your current weight and height? *
What are your goals beyond the scale? *
Why is NOW the time you have decided to get started? *
What kinds of diets or workouts have you tried to reach your goals in the past? *
If you were to be 100% honest - what do you think is stopping you from hitting your desired goals? *
On a scale from 1-10 how important is it for you to reach these goals? (1 being not important at all and a 10 being and absolute must) *
Not Important
Absolute Must
Why is now the perfect time for you to get started? *
If you're accepted to work with Bonnie and the Self Made Team how soon can you get started? IMPORTANT: If you are not ready to begin within the next 2 weeks, please do not apply at this time *
Self Made is NOT another googled diet, rather it is a program that teaches you how to lose the weight permanently and keep it off. This program is an investment in your body and wellness that will last a lifetime and save you thousands of dollars and time. How prepared are you to invest in your health, mindset, and body transformation goals? Self Made VIP is a four-figure investment. We do offer flexible payment plans. *
Anything else we should know? *
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