Lok Wellness

Lok Wellness Future Client Application

Full Name *

Email *

Primary Phone Number *

How did you hear about me?

Date of birth *

Your current weight : *

Ideal Body Weight *

Which of the following best describes your current situation? *

I feel like I am spinning my wheels. I am trying hard with my workouts and nutrition, but I can't get toned. I feel soft / fluffy.

I feel confused when it comes to my diet and nutrition. There is so much information out there and I never know if I am doing the right thing.

I was making progress, but I feel like I've stalled out and am disheartened. I don't want to get out of shape, but I don't know where to go from here.

I am counting macros, but I am at a standstill yet want to see more progress.

Food is controlling my life. I am unsure what I should eat or if I am doing the right thing. My mindset is suffering because of it.

I feel like I am on a roller coaster and I want something sustainable. I want results that last.

I feel like I know what to do but am wondering if my health may be off somewhere because I can't seem to get results.

I am very uncomfortable in my skin and it is starting to wear me down. I can see it impacting other areas of my life negatively.

How committed are you to solving this problem? *

5/10 - I don't want to improve my situation that much and am OK not making progress

7/10 - I am pretty frustrated with things and want to start feeling better

9/10 - This is affecting my confidence, energy, and how I am showing up in life. I am committed to fixing this ASAP

10/10 - I will do anything to feel better. I do not want to go another day without a sustainable, healthy, long term program that will improve my health from the inside out.

Where would you like to be 6-12 months from now?

What is holding you back from achieving these goals?

Why do you feel like now is a good time to focus on your health? *

Are you ready to face the uncomfortable and messy parts of you life? *

Yes!

No!

Custom coaching requires a minimum 6-month commitment. This is not a get fit quick plan. It is a sustainable plan that will actually change your life. Are you committed to focusing on your health for this length of time? *

Yes!

No!