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Take Control Of Your Health Without Putting Your Life On Hold

Please fill out the form below and tell us about your goals, challenges, and lifestyle so we can determine if we're the right team to help you succeed.

First Name *

Last Name *

Email *

Age *

Height(ft/in) *

Weight(lbs) *

Gender *

Occupation *

How would you rate your current activity level? *

Non Active (Little or no exercise, desk job)

Lightly Active (Light exercise or sports 3-5 days/ week)

Active (Moderate exercise or sports 3-5 days / week)

Very Active (Hard exercise or sports 6-7 days / week)

What are your current health & fitness goals? Where would you like to see yourself 6 months from now? (Lose 30lbs? Gain strength? Increase self-confidence? Improve energy? Get off medications? Be more active with your family? - Be as specific as possible.) *

Why are achieving these goals important to you? How would improving your health impact other areas of your life (family, career, confidence, relationships, leadership, longevity, etc.)? *

What have you tried in the past to improve your health and what do you feel has prevented you from achieving lasting success? *

Space is limited and we want to ensure this is a good fit. What would a successful coaching experience look like to you? What would you expect of us? *

On a scale of 1-10, how committed are you to making a permanent health change? (1 = It's not a priority, 10 = I'm ready to do what it takes to reach my goals) *

Heroic Health & Fitness is a high-touch coaching program designed for individuals who want expert guidance, accountability, and a personalized roadmap for improving their health, fitness, and quality of life. Most clients invest between $400-$1200/month depending on the level of support they need. If accepted, which best describes you? *

I'm willing to invest in myself if it's the right fit.

I'm interested in understanding the value and ROI.

Unfortunately, this is currently outside my budget.

If accepted, how soon are you looking to get started? *

If your application is approved, would you prefer a phone or a ZOOM video coaching call? *