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Preparation for Appointment - Application to chat

Please fill out this form so I can prepare for your appointment.  Without an application form from you your appointment will be cancelled.  

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Question 1 of 15

What is your first and last name?

Question 2 of 15

What is your email address AND phone number (including country and area code)?

Question 3 of 15

How did you hear about me and my 12 week program?

Question 4 of 15

Please select your call preference:

A

Zoom

B

Phone

Question 5 of 15

Which age bracket are you in?

A

20-30

B

31-35

C

36-40

D

40-50

E

50-60

F

60+

Question 6 of 15

What is your current biggest challenge with your back/neck and health?

Question 7 of 15

What are you hoping to achieve with your body and health?

Question 8 of 15

What is your biggest obstacle to achieving this goal?

Question 9 of 15

Describe your current lifestyle: ie work hours, family life, stresses, current exercise, eating and drinking habits.  

Question 10 of 15

Have you tried any treatments/therapy or exercise programs for your condition? What were they and did they help? If not, why do you think it didn't?

Question 11 of 15

Right now I

A

I have the financial resources to invest in myself and my long term goals for my body

B

I have access to the financial resources to invest in myself and my long term goals for my body

C

I don't have the financial resources and I'm going to have to keep working on my health and my body as is

Question 12 of 15

If someone advised me to spend $1100-$1500 on a coaching program to help me move more freely, reduce pain and stress, feel like myself and enjoy life I would...

A

Know it's what any serious and committed woman needs to do to move forwards

B

Be a little cautious, yet with a proven system I would do it because I'm serious about my body and health

C

Avoid at all costs, because I need/want to do things as cheaply as possible

Question 13 of 15

I believe working with a qualified and experienced health practitioner is a worthwhile investment.

A

Yes

B

No

Question 14 of 15

I will call you at the time you chose. Please commit to your appointment time by typing this sentence in the box below: "Yes, I promise I will answer the phone/zoom for my body strategy appointment".

Question 15 of 15

Finally, what's the best thing about YOU?

Confirm and Submit