Please Fill Out The Intake Form Below.
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BURN BELLY FAT BLUEPRINT

FREE ASSESSMENT CALL INTAKE FORM

Hi beautiful! Take 2-3 mins to fill out this form to LEARN MORE about how you can lose 10-20lbs in 90 days with short, structured workouts and without cutting out carbs, sweets, or takeout with our Burn Belly Fat Blueprint

To confirm, you are filling this out because you want to lose 10-25lbs+ of stubborn fat, unbig your back, regain energy, optimize hormones or health without spending hours at the gym or cutting out carbs, sweets or take-out food, right? *

Yes - I am serious, and want to learn more about reaching my dream body, without sacrificing my life.

No - I’m going to leave this page immediately.

First Name *

Last Name *

What's your Instagram handle or Facebook profile name/link (this is a great alternative in case we have technical issues for Zoom) *

What is your current occupation and how long have you been doing it?? *

Do you have a significant other? If so, are they supportive of you potentially investing in your weight loss, health, and personal growth? *

Yes, I have a significant other but any investments into my health is my decision to make so they don't need to be involved.

Yes, I have a significant other but they may need to be on the call with me to make a joint financial decision if I decide to get additional support beyond the free call.

No, I’m single AF and make my own rules, lol

Email *

Phone *

City *

Country *

Close to the end! If you were to have a weight loss and fitness program that helped you lose 10, 20, 30, 40, 50+ lbs, burn belly fat, unbig your back, get your energy back while boosting your confidence and health and you get to enjoy your favorite foods with a routine that fit your busy schedule making the Burn Belly Fat Blueprint the last coaching or weight loss program you'll ever need - would you be willing (and able) to invest in getting the help necessary to get to your goals? *

Yes girl! I have the cash flow AND savings/loan/personal line of credit to invest in myself! If I am accepted into the program I'd prefer to pay in full or make a lump sum payment/deposit to reduce my program price (due to less admin fees for transactions it saves you $$$) I'd prefer to do that!

Yeeessss, I have the cash flow OR some savings/loans/personal line of credit to invest in myself. If I am accepted into the program I'd prefer to make a lump sum payment/deposit to reduce the program price (due to less admin fees for transactions it saves you $$$) I'd prefer to do that! - girl, I'm READY!

Yes, I may not have a lot of cash flow, but I'm resourceful, I have a health spending account and/or have access to a personal line of credit or loan that I can use to make this happen because this is important to me!

Yes, my finances are tight but if I can have access to a PAYMENT PLAN I am READY to finally reach my weight loss and health goals! I can afford to get my nails/lashes done each month or my hair laid so I do have SOME cash flow to invest just not a lot so if payment plans or financing is available I'm all in!

No, honestly my budget is too tight right now I can't even afford a $10 planet fitness (gym) membership so I have no room for flexibility, there isn't anything I could cut out (e.x. getting nails, lashes, streaming services etc.) that could make room for an investment into my health but I really am ready to lose this weight and get my health on track!

On second thought, this really isn't a priority for me right now. Yes my weight and/or medical conditions are negatively impacting my long term health, body image, and leaving me feeling defeated, frustrated and depressed but I'm ok with staying stuck a bit longer, gaining more weight or having my health decline more. This will probably only become a priority to me when I'm sick enough or the doctors tell me I have to be on multiple medications or can't have children naturally.

We will be in touch! During the Zoom call make sure to have a safe, quiet space where you feel comfortable discussing anything that's been weighing on your mind and heart. This session can be emotional for some clients and we don't want you to feel like you have to censor yourself or hold yourself back because other people are around, this is your first step to PRIORITIZING YOURSELF!

Press the SUBMIT button to send this to our Coaches and we'll chat soon!

This form will get sent to our coaches to help personalize your plan during our Zoom call!