Let’s get you in the best health of your life.

Fill out the HEALTH ASSESSMENT APPLICATION below to see if you qualify for a FREE 15 minute health and wellness assessment to talk about your goals and how I might be able to help you reach them.

Your Name: (required)

Your Email: (required)

Your Phone Number: (required)

Best Time of Day To Call You: (required)

How Did You Find Me? (required)

If you had a magic wand and could change two things about the current state of your health/fitness, what would you change? (required)

Please share with me the unique circumstances in your life right now that are causing you to want massive change in your health: (required)

What have been the main obstacles for you in achieve your current health goals: (required)

What do your current eating habits look like? (required)

What does your current exercise routine look like? (required)

What are you currently doing for work/career? (required)

How would an additional $500, $1,000, or $5,000 per month affect your life? (required)

If there were no limitations, what would you like your life to look like two years from now? (required)

If you could spend your time doing exactly what you wanted, what a typical day look like for you? How would you fill your time? (required)

Are you interested in pursuing collaborations or entrepreneurial partnerships with me? (required)
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Please share any additional information you would like me to know about you when considering you for my program:

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