Name
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First
Last
Email
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Mobile
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Why do you think you're not at your desired goal right now?
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What is your occupation, and tell me about your role within that?
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Tell me about your day to day schedule.
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Be detailed in regards to your activity, (sitting or moving) and how busy your day is with work and home life.
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 has made you take action? 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
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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How much are you prepared to invest into your own health and happiness over the next 6 months?
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Less than £500
£500 - £750
£750 - £1000 (most popular)
£1000+
Whatever it takes, I'm sick of wasting time, money and energy!
Not willing to invest in my health & happiness.
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, we're very selective about who we let into our groups and coaching - why would you be a good fit?
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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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