jay@js7coaching.com

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Personalized Nutrition Coaching From JS7 Coaching

JS7 Coaching will connect with you and develop a realistic personalized action plan to help you make powerful, long-term changes in your life.

We’ll look at where you are, where you want to go, and how to overcome the roadblocks keeping you from getting there.

IMPORTANT: The more detail you can provide for me in your booking application, the better I’ll be able to serve you on the call.

$

Step 1 of 6

16%

Name*
First Last
Email*
Phone*
Date
MM slash DD slash YYYY
How did you hear about JS7 Coaching ?*

There are multiple factors that influence which nutritional methods and physical activities best suit you and your desires. The below questions will help us narrow those methods/activities down for you.
Age*
Height*
Weight*

On a scale from 1-5 (1 Horrible, 5 Beyond Exceptional) where would you rank your BODY?
- 1 - Horrible
- 2
- 3 - Average
- 4
- 5 - Beyond Exceptional
If you could achieve one result in the next 6 months and be thrilled, it would be...
What areas would you like to improve upon? (Check all that apply)*
- Select All
- Energy
- Focus / Cognition
- Long-Term Fat Loss
- Muscle Building
- Mood Enhancement
- Pain Management
- Customized Supplements
- Daily Habits and Productivity

Do you experience any of the following? (Check all that apply)*
- Diet Resistant, Hard-To-Lose Unwanted Weight
- Frequent Stomach and Digestive Trouble
- Feeling Bloated or Swollen
- Body Aches, Pains, Tightness, and Stiffness
- Poor Sleep, Insomnia, and Low Energy
- Brain Fog, Mood Swings, Anxiety and Stress
- Acne, Rashes, and other Skin Problems
Our approach may be different depending upon where you at in life. What best fits you?*
Are You SELF-EMPLOYED (aka You can control your monthly income)*
- Yes
- No
What industry are you in?*
Why are you interested in working One-On-One with Me?*

What would the ideal success mean for you if we worked together? (Please be specific)*
Why are you the ideal person for this opportunity to work with me?*

On a scale from 1-5 how motivated are you to experience these changes in your life?*
- 1 - Not Motivated
- 2
- 3 - Interested but not committed
- 4
- 5 - Extremely Motivated
Fill in the blank - I am...*
- An Excuse Maker who looks for an opportunity but then finds "reasons" not to the advantage of them.
- A Procrastinator who wants to take action but never puts the trigger until the opportunity is gone.
- An Action Taker who sees and opportunity and moves forward quickly
If you answered Excuse Maker or Procrastinator are you ready to change your patterns?*
- YES!! , I am ready to change!
- NO , I'm too set in my ways to change
- I’m an Action Taker!!!
Is there anyone, besides you, involved in this decision?*
- YES, but I will discuss BEFORE my interview so I can be decisive if I'm selected.
- NO, the decision is 100% mine to make.
Phone
This field is for validation purposes and should be left unchanged.

Providing education and guidance to people ready to end the dreaded chronic dieting cycle. We follow science-proven systematic metabolic restoration processes. No more dieting! No more fear of food!

JS7 Coaching

413 E Lockeford St Lodi, CA 95240



Lodi California

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