Custom Health & Fitness Recommendation

Energy is everything. Tell me how you feel:*

Honestly, I feel like crap. My energy is non-existent and I struggle to stay positive.
My energy is up and down and so is my mood.
My energy stays pretty high, and I consider myself well balanced and generally positive.
I have AMAZING energy ALL THE TIME. I love life and today is always THE BEST DAY EVER!!!

Do you like to get physical? Tell me about your weekly physical activity!*

Very little movement each day other than normal daily activities (no physically demanding job either).
I have a physically demanding job, but do not add extra working out on top of that.
Work in Progress. I make a conscious effort to workout 1-2 times a week)
I have a physically demanding job, but add on workouts when I can. (Nurse working 12 hour shifts etc)
Fitness is on my Mind. I try to workout 3-5 times a week.
Working out is a priority to me. I do a legitimate workout once a day at least 5-6 days a week
LOVE my workouts. Some call me obsessed, I call it dedication! It's my form of therapy!

What kind of workouts do you typically enjoy doing?*

Choose as many as you'd like

For the love of food, tell me about your current eating habits:*

I eat clean - If it’s processed, it’s not getting near this body.
I eat generally pretty well but fall off the wagon every now and then and have to get back on.
I have an awareness of healthy eating and make a conscious effort…but late night ice cream or potato chips are kind of my jam.
Fast food, sodas, and packaged snacks are no strangers to me.

Tell me what a typical day of eating looks like for you right now.*

Do you use any supplements?*

If yes what?

Do you drink/take anything for energy? (coffee, energy drinks etc..)*

Tell me how well you slay the stress in your life:*

I rarely feel "stressed out"
There is stress in my life, but I tend to cope fairly well and rarely freak out.
I have multiple areas of stress in my life, and I have a difficult time keeping it all together.
Stress is an all the time thing for me, and I feel on the verge of a breakdown frequently.

Check all that apply*

Choose as many as you'd like

You are a*

Female
Male

What is your age range?*

Check any of the following that apply to you:*

Choose as many as you'd like

Do you have any other medical conditions or injuries?

What do you struggle with the most as far as your nutrition and fitness?*

Knowing what to eat? How much to eat? Time? Injuries? Limitations?

What are your health and fitness goals? Having a vision and measurable goals is SO important!*

Please take your time answering this question

WHAT or WHO really motivates you to live a healthy and fit lifestyle?*

Who do you admire? Who do you follow? Who do you look to for inspiration? WHAT inspires you? It could be a friend, public figure, your kids... anything!

What's your reason for wanting to make changes now?*

(Think DEEP here --- your kids, health, family...)

Any other information you would like for me to know about you? I'll be in touch within 24 hours of receiving your application! Be sure to check the email you provided. I can't wait to get to know you more!

Share with me your current weight.*

Name

This field is for validation purposes and should be left unchanged.

I know sharing some of the info on this form can make you feel a little vulnerable, but I can promise you, that you won’t regret getting started with me!

My goal is helping you in making lifestyle changes and achieve sustainable results, so it’s important that I get to know your needs, goals, and struggles. So please take it seriously 🙂

Fill out the form below and I’ll get back to you in the next 24-72 hours.

Custom Health & Fitness Recommendation

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