First Name *

Last Name *

Email *

What are your top health goals for the next 90 days? *

Why is achieving these goals important to you, both in your day-to-day life and in the bigger picture of who you want to become? *

What's the biggest obstacle that's been holding you back from reaching those goals so far? *

If that obstacle disappeared in the next 30–60 days, what would feel different in your life, body, or confidence? *

What kind of support do you most need right now? *

Accountability and consistency

A clear plan tailored to my body and lifestyle

Support around mindset or motivation

Expert guidance and feedback

A sustainable structure I can stick with

(Select up to 2)

This coaching program is a high-touch experience and requires a financial investment of $3500 or more, and a 6-month commitment. If we both feel it’s the right fit, are you ready to make that kind of investment in achieving your health goals? *

Yes – I’m ready and able to invest in myself

I’m ready to invest, and I’d need a flexible payment plan to make it work

No – I’m not in a place to invest in coaching right now

If you're accepted into Heal By Design, when would you want to get started? *

Right away

Within the next month

I’m not ready anytime soon

Are you ready to make a confident decision now if it’s a great fit? If you're invited to book a free consultation, are you committed to showing up fully prepared, having already talked to anyone who needs to be involved in a financial decision (such as a spouse)? *

Yes – I’ll be ready to decide, and I’ve already had that conversation

Yes – I commit to having that conversation before the call, so I’ll be ready to decide

No – I haven’t talked to anyone yet and would not be ready to make a decision on a call

Is there anything else you’d like to share about your health journey or your desire to be part of this program? *

I consent to receive communications and understand I can opt-out at anytime.

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