form – Fit Empire

First name

Last Name

Instagram Handle

Phone

Date of birth

Where are you currently located? *

How long have you been following me? *

Which best describes your nutrition for the last 30 days?

Do you have any ongoing and limiting health issues I should know about as your coach?

What is your occupation and how does it affect your fitness goals?

Which of the following best describes your current goals/challenges? (select all that apply)

I want to get toned (lose fat) I want to build my curves (build muscle) Improve Performance (strength, endurance, etc.) I want to improve my overall health, increase energy, etc.

What are the top 2-3 things holding you back from reaching these goals? *

What is the biggest hurdle you’ve been trying to overcome with your fitness? *

Please attach a photo of your current physique from the front standing in a bikini or workout gear so I can serve you best (ANY PICTURE WORKS, IT DOES NOT HAVE TO BE TAKEN NOW) (THESE ARE 100% CONFIDENTIAL AND WILL NOT BE SHARED WITH ANYONE BESIDES COACH HEATHER! THESE ARE IMPORTANT FOR ME TO SEE HOW I CAN HELP YOU SO DONT BE SHY) *

How did taking this photo make you feel and how are you hoping to feel differently 6 months from now?

My program is NOT a one size fits all, cookie cutter, cheap program. My program IS a hands on customized training experience made for YOU, YOUR NEEDS, and YOUR GOALS. HOW WILL JOINING HOUR BODIES AND REACHING YOUR GOALS CHANGE YOUR LIFE FOR THE BETTER??

How prepared are you financially, physically, and emotionally to invest in transforming your life right now?

I have the financial resources, I am READY TO DO WHATEVER IT TAKES, and I am READY TO REACH MY GOALS! My budget is tight and I have less than $300/month to invest in myself, but I am ready to change and commit if it means results I am not financially ready to invest in myself.

Anything else you'd like to add before applying?

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Ready to Begin? Contact Me for a FREE Evaluation

Ready to Begin? 
Contact Me for a FREE Evaluation