What is your #1 fitness goal right now? (Select all that apply) *

Tone up and get leaner

Build strength and muscle

Finally stay consistent with fitness and food

Improve body confidence and feel good in my clothes

Create a healthy routine that fits my life and schedule

Increase energy and feel better day-to-day

Why is this goal important to you personally? (Select all that apply) *

I want to feel confident and energized in my body

I’m tired of feeling uncomfortable or stuck in my own skin

I want to feel strong, sexy, and empowered

I want to improve my health for the long run

I’m doing this to show up better for my family or loved ones

I want to break free from all-or-nothing habits and finally feel in control

Have you tried to reach this goal before? What did you try? (Select all that apply) *

Worked with a coach or trainer

Followed a fitness app or home workout program

Joined a gym but couldn’t stay consistent

Followed a restrictive diet (keto, fasting, paleo, etc.)

Took supplements or fat burners

Tried random Instagram/YouTube workouts

Didn’t have a clear plan or accountability

On a scale of 1–10, how serious are you about achieving this goal right now? *

What do you think has been holding you back from staying consistent? (Select all that apply) *

Lack of structure or routine

No clear workout plan

No accountability or support

Not knowing how to eat or fuel my body

Lack of time due to work, family, or life

Emotional or stress eating

Fear of failing again or wasting time/money

If you were to reach your goal, how would that impact your life? (Select all that apply) *

I’d finally feel confident and happy in my body

I’d have more energy to keep up with life

I’d feel better in my clothes and love how I look

I’d stop hiding my body or avoiding social situations

I’d feel mentally and emotionally stronger

I’d rediscover activities I used to love

What is your monthly budget for a fitness program? *

$100-$200

$200-$400

$400-$600

$600+

Who else, besides yourself, will be involved in making decisions about your fitness journey? *

Do you rely on unhealthy habits to cope with emotions? *

Yes

Would you be interested in any mental health or medical services? *

Mental health support

Medical support

Both

Full Name *

Email *

Phone

Instagram Handle

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