Survey Page

First Name *

Last Name *

Email *

Mobile *

Country *

Birthday *

Birth Time (if unknown, please use your best estimate) *

Birth Location *

Based on what I taught you in my class, what is the main problem you are experiencing right now? *

Describe for me where you are right now in terms of your results? Why did you request this session? Please include any past dieting and weight loss attempts in detail. *

If your above answer describes where you are right now, then how would you like your circumstances to be different? Where instead do you want to be? What sort of result would you like to achieve? *

What is going on in your world right now that makes it a MUST for you to achieve these goals? *

Thank you. Now, what is the big challenge right now you are facing in reaching your goals? *

If someone said that you needed some level of coaching in order to reach your outcome, what would your response be? *

Our coach will call you at the designated time at no cost to you, and we expect you to treat it as if you had paid. Please confirm that you are aware of the agreed TIME and will be available as promised, by typing in this wording please: "YES, I PROMISE I WILL BE THERE FOR THE SESSION." *

Lastly, between zero and 10, how committed are you to finding a solution to your challenges right now? (zero = not interested, 10 = it's an absolute must) *

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