5 Days Free Application Form
Name
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First
Last
Email
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Mobile
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How much money have you spent trying to achieve your goals?
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Please be as detailed as possible about the diets, plans & programmes you have tried before.
How does that make you feel?
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Why do you think you're not at your desired goal right now?
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On a scale of 1-10, how do you feel about your body right now?
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10 = you would walk down the street naked.
On a scale of 1-10, what are your energy levels like right now?
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1 = can't get out of bed.
Please answer honestly - do you;
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Smoke and/or vape?
Drink alcohol?
Eat takeaway?
Eat other junk foods?
None of the above
If the answer is Yes, please check the box.
What made you fill in this form today? Please be as detailed as possible.
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Example - Had enough, seen no results, lack of progress etc.
What have you tried in the past? What worked? What didn't work?
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Please give as many details as possible
What are you looking for from a weight loss program?
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Sustainable weight loss and toning
Support and guidance from a like-minded group
Non-intimidating environment
People asking if I've lost weight
ALL OF THE ABOVE
Which describes you best?
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Excuse maker that's always looking for a magic pill
Procrastinator that always puts things off
An action taker that wants to make changes NOW
Finally, I'm very selective about whom I let into our groups - why should I choose you?
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Please read the statement below and check box to proceed.
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I confirm
I confirm that I would like to proceed with my application. As a Nutrition Body Mind client, I understand that I will need to invest in myself and confirm that if my application is successful I will be committed and dedicated.
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