Quantum Wellness Mastery

First name

Last name

Email

Age Range

under 35

35-45

45-55

55+

My preference is to work with a coach:

1:1

In a small group

A combination of 1:1 & small group

No Preference

This is how often I could realistically commit to calls:

Weekly

Bi-weekly

Monthly

These are dates/times that work for me: *check all that apply

Weekdays at lunch or early afternoon

Weekday evenings between 5pm - 7pm

Weekday evenings after 7pm

Saturday mornings

Which of these is MOST important to you when deciding whether or not to join a program?

Learning something new

Supportive & engaged community

Being provided with realistic & clear strategies

Being held accountable

All are equally important

What is your current activity level:

Sedentary (no judgement)

I move but I could be more active

I exercise regularly (3 to 5x a week)

I am extremely active

Additional Comments (optional)

Yes! I am interested in learning more about your Quantum Wellness Mastery program: