B.E.S.T. Plan Entry Questionaire

Looks like you're taking your fitness and well-being to the next level. Awesome!

Please complete the following entry form so that we can get started on customizing your program. A coach will contact you within 24 hours to set up your program.
Full Name *

First Name Last Name
Gender

Male Female
Age
Phone Number *

Area Code Phone Number
E-mail *
How Did You Hear About The B.E.S.T Plan? *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
What do you do for a living?
What days do you work?
What are your work hours?

How Stressful Is Your Job?

	1	2	3	4	5

1 is Not At All, 5 is Very Stressful

List any past diets and/or weight loss programs you’ve tried in the past 10 years
How would you describe your body?
How would you describe your mental outlook on your life and/or life in general?

How committed are to making a lifelong transformation when it comes to your fitness and well-being?

	1	2	3	4	5

1 is ”I’ll just see how it goes”, 5 is “fully committed and will do whatever it takes!”

Are you emotionally prepared to look at and deal with other areas in your life that may seem to have nothing to do with diet and nutrition?

Yes No (if you answered "no" please tell us why below.)
If you answered "no" above
What are your long term goals in regards to fitness and overall well-being?
Are you currently engaged in an exercise program?

Yes No (if you answered "no" please tell us why below.)
If you answered "no" above
Please describe your diet/eating habits in detail:
Please tell u s why you would be a good candidate for this program.
Should be Empty: