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Email*
First Name*
Last Name*
Age
Best contact number
How do you prefer to be contacted?
How did you hear about Reveal Coaching?
Google searchReferralInstagramFacebook
What do you want to achieve?
Lose weightGet strongGain confidence with foodIncrease energy levelLook better nakedFeel confident with how I feel about myself
How much weight do you want to lose?
0-10lbs10-20lbs20-50lbs50+lbs
What are your obstacles?
TimeEducationBaby weightI have kidsCurrent schedule/Work life balancePortion controlLast stubborn 10LBSOther:
Have you hired a coach before?
YesNo
On a scale of 1-10 how motivated are you for this goal? (10 being super motivated)
Choose12345678910
On average how many hours of sleep do you get?
4-5 hours5-6 hours6-7 hours7-8 hours8-9 hours
How many alcoholic drinks do you average per week?
I don’t drink1-3 drinks per week4-6 drink per week7-9 drinks per week10+ drinks per week
How do you feel in the morning upon waking up on average?
RestedLittle foggyFantasticPretty tired and want more sleep
Current weight (if comfortable)?
Goal weight?
How would you rate your current stress levels? (10 being massively stressed)
Would you consider your work sedentary?
How many meals do you eat in a day?
1-22-33-44+
Do you snack in between those meals?
How often do you eat out weekly?
1-2 times2-3 times3+ timesrarely ever
In a perfect world, if you could not fail, how many pounds would you want to lose?
What has been the most diffuclt thing about losing weight in the past?
Thank you for you interest in Reveal. Taking the first step is often the most difficult part, so I applaud your initiative & motivation in achieving your personal goals. I look forward to the opportunity to partner with you on this journey, and help you discover your personal breakthrough.
I will be in touch very soon, typically the following business day, to cover my program and answer any questions you may have. Congrat's on taking action!
Talk soon! Coach Matt
