What is your age? *

Under 30

30-39

40-49

50-59

60+

What is your current weight? *

What do you currently do for work? *

What would you most like to accomplish with your health right now? *

Lose 20-30 pounds

Lose 30-50 pounds

Lose more than 50 pounds

Improve my energy, confidence, and fitness

Improve my health markers such as blood pressure, cholesterol, or blood sugar

Build strength and get back in shape

A combination of these

What is making that hardest for you right now? *

I struggle to stay consistent

I don't have enough time

My nutrition falls apart when life gets busy

Stress or emotional eating gets me off track

I travel or eat out frequently

I have injuries, aches, or limitations

I lack accountability

I know what to do but struggle to follow through

I'm overwhelmed by conflicting fitness information

I've tried multiple programs and nothing has lasted

common.other_option

Select all that apply

What have you already tried to lose weight or get back in shape? *

What usually causes you to fall off track? *

Work gets busy

Stress

Travel

Family responsibilities

Weekends or social events

Lack of accountability

I get discouraged when results slow down

I try to be perfect and eventually burn out

I lose motivation

I'm not really sure

common.other_option

Why is making this change important to you now? *

If nothing changes over the next 12 months, what concerns you most? *

My health getting worse

Gaining even more weight

Having even less energy

Losing more confidence

Not being able to keep up with my family

Needing more medication

Continuing to start over again and again

Honestly, I haven't thought that far ahead

common.other_option

What level of support sounds most like what you need right now? *

A simple training system I can follow mostly on my own

Training plus a community and added accountability

Personalized coaching for my workouts, nutrition, accountability, and progress

High-touch coaching with additional mindset and personal support

I'm not sure. I want Heartletics to recommend the best option

If Heartletics feels like the right solution, what level of investment are you realistically prepared to make in your health over the next 90 days? *

Less than $500

$500-$1,499

$1,500-$2,999

$3,000-$4,999

$5,000+

If we determine that Heartletics is a good fit, when would you ideally like to get started?As soon as possible *

As soon as possible

Within the next 1-2 weeks

Within the next 30 days

In the next 2-3 months

I'm mainly researching my options right now

How ready are you to make a real change right now? *

10/10 - I'm ready and I want help now

8-9/10 - I'm very serious about making a change

6-7/10 - I want to change but still have some hesitation

4-5/10 - I'm interested but not ready to fully commit

1-3/10 - I'm mostly exploring right now

What's the best way for Joe or a Heartletics team member to follow up with you about your evaluation? *

Text message

Phone call

Email

First Name *

Email *

Phone *