Ready Set Reset Form – Communitas Wellness // Nikki Humphrey Fitness

Name*

First Last

Email*

Phone*

How did you find this program?*

Facebook
Instagram

How do you want me to connect with you?*

Text Me!
Email Me!
Call Me!

Are you SICK and TIRED of having excess body fat or FEELING tired all day long? Do you want to wake up confident in your skin and happy about life?*

YES!
Maybe... I'm not sure it's possible
No

Do you have at least 10 lbs of body fat to loose or do you want to gain lean muscle? Is your goal less inflammation?*

Yes, 10 lbs+ of fat to lose!!!
Yes, I want to gain lean muscle
I want to reduce stress and inflammation

Will you be seriously committed for 6 weeks with a "NO EXCUSES" attitude? AND...Are you coach-able?*

YES!
I am not sure
No

Will you be open to showcasing your RESULTS to inspire others and show other people in pain what is possible? Do you have any friends or family members who may join you on this journey - for accountability and increased results?*

Yes, I am willing to share my story and inspire others
No, I am not willing to share my story
I can think of a few people who may be interested in joining me

Do you currently use supplements? Are you a person who eats clean or are you struggling with what to eat?*

What are your specific body goals and WHY do you want to achieve this goal? Please be as specific as possible*