Ultimate Portion Fix Coached Group Focus on Meal Prep
RequiredRequired Question(s)
1.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:
Country:
Cell Number:
What is your age?:
What is your current weight?:

Required 2.

Have you participated in a health and fitness accountability or support group before?


Yes
No
  • Comment:

  • 500 characters left.
Required 3.

Have you tried other nutrition programs/diets in the past?  If yes, what have you tried?


Yes
No
  • Comment:

  • 500 characters left.
Required 4.

If so, what was it about them that worked or didn't work?

 

1000 characters left.
Required 5.
What do you hope to achieve by joining a group and finishing the Ultimate Portion Fix program?  Please check all that apply.
Weight loss
Weight gain
Add lean tissue
Gain strength
Increased energy and stamina
Improve my health
Prevent disease and illness
Improve eating habits
Gain consistency with healthy behaviors
Better quality sleep
Learn how to be a better role model for my loved ones
Reduced stress
Change in body composition
Be in an environment that supports my health goals
Try something new
Learn how to follow a plan/program that meets my fitness goals
Other  
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  • 500 characters left.
Required 6.

Do you have any restrictions to the way you eat?

 

350 characters left.
Required 7.

How would you describe your currently nutritional status?  (Please base your response on consistency over the past 6 months)

Poor (i.e., mostly processed foods, eat out multiple times per week, sugary beverages daily, very few whole foods)
Fair (i.e., eat mostly whole foods, some processed, eat several servings of fresh fruits and vegetable weekly, limit sugary beverages to 1 -2 times per week, eat out 1 - 2 times per week)
Good (i.e., eat mostly whole foods, rarely eat processed foods, eat several servings of fresh fruits and vegetables daily, focus on organic, grass fed and non-GMO, rarely eat out, never drink sugary beverages)
Other  
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Required 8.

How would you describe your current fitness level?

Low
Fair
High
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Required 9.
Do you plan to exercise?
Yes
No
Other  
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10.

Is there a type of workout you prefer? (dance, cardio, weight training, yoga)

 

50 characters left.
Required 11.

Are you currently working with, or have access to, a Team Beachbody Coach?

Yes, Kelly Amos is my coach
Yes, but not Kelly Amos
No, I am not working with a Team Beachbody Coach
Other  
  • Comment:

  • 500 characters left.
Required 12.
Please click here to select your kit.  If you need help deciding which kit is best for you contact Kelly here.  We then need to discuss your responses, what is the best way to reach you?  (Please be sure to provide the contact information for your preferred source of communication)
email
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Text
Other  
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