Premium Coaching with Mike Whitfield Application Question Title * 1. Full Name Question Title * 2. Email Address Question Title * 3. Age Question Title * 4. Gender: Female Male Question Title * 5. Do you have at least 15 pounds to lose? Yes No Question Title * 6. What's your exercise level? Beginner Intermediate Advanced Question Title * 7. What are you hoping to experience from this coaching program? (Check all that apply) Fat loss More energy Clothes fitting better More confidence Other (please specify) Question Title * 8. What's your #1 frustration right now? Info-overload Can't find a plan that is customized for my lifestyle I need accountability I jump from one diet or exercise plan to another Other (please specify) Question Title * 9. Are you willing to work together on specific, measurable, WEEKLY goals? Yes No Question Title * 10. Will you commit to a WEEKLY "Accountability Check-in"? (exceptions such as vacation are OK) Note: you'll be able to communicate with me at any time, but will be REQUIRED to do a weekly check-in. Yes No Question Title * 11. Are you willing to be transparent with me so we can dial in a specific action plan to remove the obstacles keeping you from achieving your ideal weight? Yes No Question Title * 12. Are you willing to commit to this program for a minimum of 12 weeks? Yes No Question Title * 13. Are you serious enough to financially invest in this unique coaching program? Yes, I have the financial resources needed to invest in myself I can get the financial resources needed to invest in myself No, I am not ready to financially invest in myself at this time Please note that all applications are reviewed personally by me. Please allow up to 5 business days for review. Approved clients will be notified from me personally. Premium coaching is currently just $297 billed every 30 days. This is subject to change. Submit