Application For Orientation Call

How did you hear about us?*
Occupation*
Age*
Weight*
Do you need help achieving your health and fitness goals?*
- Yes
- No
- Not sure
Are you self motivated?*
- Yes
- No
Can you be self directed if the appropriate program is provided?*
- Yes
- No

What is your goal? Lose 20 lbs? Gain 20 lbs. of muscle? Feel better? Look better? Have more energy? Be specific. Doesn't just have to be a physical goal.*
What would be the most important criteria for your success as we work together?*
What have you tried in the past and why hasn't it worked for you? What's stopping you from hitting your goal?*

On a scale of 1-10... 1 being I'm satisfied where I am and 10 being I'll do anything to reach my goal. What number are you?*
Are you willing to use a credit card, PayPal credit, or get financially resourceful if you feel it is what you need?*
Does your spouse or significant other support you? (Meaning they will give you a thumbs up on whatever you decide)*
- Yes
- No
- Not applicable

Our programs are about teaching and learning, not just ordering you around. We are not the cheapest, but we solve your struggles forever through education and sustainable practices and techniques.
With that said, are you willing to invest financially to reach your goals? (Be ready to move forward on the call IF YOU and us decide you're a good fit for this program. IF you are not a good fit we will let you know and refer you to someone else)*
If accepted how soon are you looking to get started? (if you aren't ready please just wait and schedule when you can. We expect those who feel it's a fit to move forward. Those who don't take actions are 95% more likely to continue to do nothing)*

I realize I'm booking a real time slot with you.*
- Yes
- No
I will be available to take the call in a quiet, distraction free environment at our agreed upon time.*
- Yes
- No
Do you have a preference who you speak to?*
- Kelly Schmidt
- Tina Schmidt
- No Preference
Which program are you interested in?*
- Lifestyle Blueprint
- Lifestyle Premier