First Name *

Email *

How would you describe your sleep lately? *

I wake up between 2–4 AM and can’t fall back asleep

I sleep a lot but never feel rested

I fall asleep fine but wake up groggy

I’m wired at night and can’t fall asleep

Sleep is undisturbed and restful

How’s your weight behaving these days? *

I’m gaining belly fat no matter what I do

I’m eating healthy but still feel inflamed or puffy

I’m unintentionally losing weight or feel weak

No big change—just slower and more sluggish

I feel strong and lean

How would you describe your mood lately? *

Anxious or edgy—like I can’t turn my brain off

Low, weepy, or emotionally flat

Irritable, reactive, or snappy over little things

Up and down—it changes daily

Hopeful and excited

What’s going on with your focus and memory? *

I can’t concentrate—I’m constantly foggy

I forget words or what I’m doing mid-task

I get through the day, but my brain is tired

Honestly? My brain feels pretty sharp

What’s your current cycle status? *

Still cycling, but things feel “off”

Heavy, painful, or unpredictable periods

My period is disappearing or erratic

I haven’t had a period in 12+ months

What’s your craving profile like? *

I crave sugar or carbs—especially in the evening

I need caffeine just to function

I go for salty or crunchy snacks

I manage cravings well with real meals

How often do you feel like yourself lately? *

Rarely—I feel like a stranger in my own body

Some days yes, some days no

I’m getting through the day, but just surviving

Most days, I feel strong and in control

How long have you felt stuck with your weight or energy level? *

Less than 6 months

1–2 years

3–5 years

5+ years

How motivated are you to make changes right now? *

What’s your biggest motivation for getting healthy right now? *

What’s harder for you? *

Sticking to a plan

Staying consistent with workouts

Managing stress or emotions

All of the above

Are you willing to invest in coaching if it’s a good fit? *

Yes, if it’s right for me

Maybe — I’d need to understand the value

No, I can’t invest right now

To help determine which level of coaching is right for you, please share your monthly income: *

Do you currently follow a specific nutrition plan? *

No, I eat intuitively or without a set plan

Yes, I follow low-carb or keto

Yes, I do intermittent fasting

Yes, I follow a structured meal plan or macros

Other

How often do you work out each week? *

0–1 times per week

2–3 times per week

4–5 times per week

6+ times per week

What type of workouts do you typically do? *

Have you tried any of the following approaches before? *

What’s your biggest current challenge when it comes to your health? *