Ebony Stepp

PRIVATE APPLICATION

Healthy Body Method Transformation Application

This is an application for a Strategy Call with Ebony. Once you apply, you'll be able to select a day and time to speak with her to go over your application and see if its a good fit to work together.

Name

First Name *

Last Name *

Phone Number

Phone number *

Email *

How much weight do you want to lose? *

Less than 15 pounds

45-60 pounds

20-40 pounds

65+ pounds

What symptoms are you experiencing? Select all that apply. *

Inflammation

Chronic Fatigue

Bloating

Aching Joints

Fluid Retention

Puffy face, hands, feet

None of the above

Other

What symptoms are you experiencing? Select all that apply. *

Pre-diabetes

High Blood Pressure

PCOS

Sugar Cravings

Weight Gain

Belly Fat

None of the above

Other

What symptoms are you experiencing? Select all that apply. *

Arthritis

Joint Pain

Restless Sleep

Digestive Issue

Brain Fog

Heart Palpitations

Low Libido (sex drive)

None of the above

What have you tried in the past to lose weight? Select all that apply. *

Keto

Paleo

Atkins

Weight Watchers

Excessive Workouts

Low Calorie

Diet Pills

South Beach

Elimination

Whole 30

Other

Have you had weight loss surgery? *

Yes

No, but I'm considering it

No

Why do you want to lose weight? Select all that apply. *

More Energy

Medical Diagnoses

Arthiritis

Auto-immune

More Confidence

Be More Active

Be Healthier

Look Better

Feel Better

Reduce Pain

None of the above

Other

What is holding you back from achieving your goals? Select all that apply. *

Nothing is working

Don't know what to do

Lack of motivation

Lack of support

I lose but gain it back

Hit a plateau

Don't know what to eat

Medical issues

None of the above

Other

How ready are you to start working towards the goals? *

Ready now - let's do this!

Ready - but have questions.

Why would coaching with Ebony be a good fit for you? *

If it's decided that you and Ebony are a good match, are you ready and willing to invest the money needed to achieve your health goals today? *

Absolutely! I have financial resources and am ready to invest in my health and weight loss today!

Yes, but I'll need a payment plan or funding options.

No, I'm not ready, able or willing to invest in myself and health right now.

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Please fill out the form below so we can prepare for your appointment.
If we don’t get an application from you your appointment will be canceled.

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