First Name *

Last Name *

What's the best email to contact you? *

What's the best phone number to reach you? *

Use country code 1 for US and Canada

What is your age? *

What is your occupation? *

If you have kids, how many kids do you have? *

Are You Interested In Working With A Specific Scooby Health Coach? *

Please indicate if you are following any Scooby Health coaches listed below on Instagram: *

What's your current activity level? *

None. I spend most of my day sitting (less than 5000 steps per day)

I am active 3-5 days a week and spend a large part of my day on my feet (less than 10,000 steps per day)

I am very active 6-7 days a week and have a physically demanding job (greater than 10,000 steps per day)

What is your weight training experience? *

I have no experience weight training

I have been weight training less than 2 years

I have been weight training greater than 2 years

I have been weight training greater than 5 years

How often do you currently weight train? *

I do not weight train

I weight train 1-2 times per week

I weight train 3-5 times per week

I weight train 6-7 times per week

What are your current diet/nutrition habits? *

Very poor! Help!

Some good days, some bad days - very inconsistent

I eat "healthy" but lack the knowledge or motivation to reach my goals

Great! I track macros and follow a consistent meal plan

Why are you interested in hiring a coach? *

How did you hear about us?

If you have an Instagram handle, please add it here: