apply22







Name
Email
Company
Phone
State
What time zone are you in?

Please describe the biggest challenges(s) you are having with regards to your weight, health, and or lifestyle.

On a scale of 1-10 (10 being most important), how important is it for you to solve this problem now? Why?

What do you think is the #1 obstacle that prevents you from achieving your goals?

What had you tried in the past to resolve this issue?

What would you like to accomplish in the next 3 months? 6 months?

Are you ready to take action NOW to get this challenge solved or are you PREPARING to take action to get this solved in the near future? (Please answer either “I am ready to take action NOW” or “I am PREPARING myself to take action at a future date”.

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