StrongSelves

✨ REIGNITE: Your 12-Week Summer Reset

Questionnaire

You’re standing at the edge of something powerful — a chance to reclaim your strength, vitality, and the life you deserve.

Before we meet, I want to invite you to complete a short questionnaire.

What’s your first name, gorgeous?

And your last name?

Email Address

Birthday

Month

Day

Year

How did you hear about us?

Hi Love, this isn’t just any form — it’s designed to help you get clear on what’s really holding you back and start stepping into the confident, empowered woman you’re becoming.

1- On a scale of 1-10, how would you rate your current energy, strength, and overall vitality?

Current Energy & Vitality

2- What is the biggest frustration or pain you’re experiencing right now that you want to change?

Biggest Frustration or Pain

3- What do you think it’s costing you—physically, emotionally, or in your relationships—to stay where you are?

Cost of Staying Stuck

4- Imagine 12 months from now, having completed this program—what does your life look like?

Future Vision

5- What would it feel like to wake up every day strong, pain-free, and confident in your body?

Daily Feeling

6- What kind of woman do you want to become through this journey?

Identity Shift

7- Transformation requires commitment. Are you ready to prioritize yourself and take massive action for the next year?

Yes

No

Commitment to Self

8- What does investing in yourself and your future mean to you?

Investment Mindset

9- What fears or doubts do you have about committing to this program?

Barriers to Commitment

10- This program is designed for women ready to step into their power and create lasting change. Are you ready to make that decision?

Yes

No

Ownership of Decision

Logistics & Medical History

1- What training group would you like to be with? (Check all that apply)

7:30 AM

8:30 AM

5:30 PM

2- Do you have any current or past injuries, or past surgeries we should be aware of?

2- Any medical conditions (e.g. diabetes, heart issues, hormonal imbalances) that may affect your training?

3- Are you currently pregnant or postpartum? Have you ever given birth? If so how many times and were they vaginal or C-section? *This helps us understand how in-depth we need to be with your pelvic floor training when creating your custom program.

4- Are you cleared by a doctor for physical activity?

Final Thoughts

Imagine yourself 12 months from now after completing this program—how different do you want your life to be?

Completely transformed

Somewhat improved

About the same

Other

How ready are you to invest in a program that transforms your mindset, nutrition, and fitness?

Ready now, let’s do this!

I’m close, just need a bit more info

Not ready yet, but interested in learning more

Other

What is your t shirt size? (Completion Gift)

Thank you!

Thanks again for taking the time to thoughtfully respond to our questions. We'll use it to have a productive conversation with you about your health and fitness goals and to prepare how best we'll be able to support you. See you soon!