Name *
Phone *
ex: for the US its +1 followed by your number 111-111-1111
ex: PST, EST, GMT, etc.
... if you prefer not to say then just put ":)" in the description (totally OK!)
What are you hoping to gain from working with me? How can I best help you with your fitness needs?
THIS IS LESS FOR ME AND MORE FOR YOU. Be brutally honest here.... 10... I am willing to do everything and anything in my power to get this done. 8... Incredibly dedicated 6... Definitely motivated 4... I am motivated (but I struggle with this sometimes) 2... I am not really sure about this whole life change thing 0... Why am I even filling this form out?
... this does not count years spent doing athletics unless you did consistent intense training in the gym
... its okay if you don't have one... just write down your favorite food if not applicable :) (mine's bananas).
... this information will always be kept private... I just want to know so I can best help you with your own goals... and I won't judge you if you have a condition (especially cuz mental health is stigmatized dude).
I have read and agree with the terms below (SCROLL DOWN THE PAGE TO CHECK THE BOX ) *
IMPORTANT LEGAL DISCLAIMER RISKS OF PRODUCT USE This website’s content is not a substitute for direct, personal, professional medical care and diagnosis. None of the meal plans or exercise programs should be performed or otherwise used without clearance from your physician or healthcare provider first. The information contained within is not intended to provide specific physical or mental health advice, or any other advice whatsoever, for any individual or company and should not be relied upon in that regard. We are not medical professionals and nothing on this website should be misconstrued to mean otherwise. There may be risks associated with participating in activities mentioned on our site for people in poor health or with pre-existing physical or mental health conditions. If you do have a pre-exiting condition, you are held responsible for letting us know BEFORE we start coaching if you or your doctor feels it is relevant for us to know. If changes are made throughout the course of coaching to let us know immediately. If you choose to participate in these risks, you do so of your own free will and accord, knowingly and voluntarily assuming all risks associated with such dietary and physical activities. These risks may also exist for those who are currently in good health right now. As with any exercise program you assume certain risks to your health and safety. Any form of exercise program can cause injuries, and our programs are no exception. It is possible that you may become injured doing the exercises in your program, especially if they are done with poor form. Be aware that our programs (like any other exercise program) do involve a risk of injury. If you choose to participate in these risks, you do so of your own free will and accord, knowingly and voluntarily assuming all risks associated with such exercise activities. These risks may also exist for those who are currently in good health right now. We are not medical practitioners. Our advice whether it be on our website, in our meal plan's, exercise program's or via email coaching, none of it is meant as a substitute for medical advice. You must consult your doctor before beginning ANY meal plan or exercise program, no exceptions. You are using our plans, program's, workout's and coaching at your own risk and we are not responsible for any injuries or health problems you may experience or even death as a result of using our programs. It is to be made clear that we are not responsible for any injuries or health problems you may experience or even death as a result of using any of our products or services. GENERALLY EXPECTED RESULTS Although our products and services are intended to be fully implemented, sometimes they are not, which could result in a lack of progress/results for the user. If you implement the products and services from us correctly you should see amazing results, however it must be disclaimed that even when consumers implement any products or services in full from us it is still possible they will not get the results they may have expected and it is also possible they will not lose fat or gain muscle or achieve any positive results of any kind. TESTIMONIAL DISCLAIMER All the transformations and testimonials are real. However, it must be disclaimed that these testimonials are not claimed to represent typical results with our meal plan's and workout program's.  They are meant as a showcase of what the most motivated and dedicated people can achieve by following our personalized meal plan's and workout program's. Your results may vary and you may not get the same results compared to someone else when using our services due to differences in your individual exercise history, genetics, and personal motivation/dedication. The end results you get will depend upon the individual and how much effort you put in. IMPORTANT SUBSCRIPTION BILLING INFORMATION If you purchase our Program you will be automatically charged every period. In order to cancel your subscription simply send an email to or by using the contact tab on the homepage and requesting to cancel your membership. However, it should be noted that payments will continue until the end of the month (the end of the pay period) even if canceled. Do you have questions about? Send us an email! You can contact the Customer Support team at and we will be more than happy to answer any of your questions! Privacy Policy YOUR PRIVACY IS IMPORTANT Stronger Self Media is committed to protecting the privacy of our site visitors and customers, we fully appreciate and respect the importance of privacy on the Internet. We will not disclose information about our customers to third parties except where it is part of providing a service to you - ex: arranging for a product to be sent to you, carrying out credit and other security checks and for the purposes of customer research and profiling or where we have your express permission to do so. YOUR CONSENT We will not sell your name, address, e-mail address, credit card information or personal information to any third party (excluding partners from whom you may have linked to our site) without your permission. COMMUNICATION & MARKETING If you have made a purchase from my store I may occasionally update you on our latest products, news and special offers via e-mail. You will always have the option to opt out of the email service. COOKIES A cookie is a small information file that is sent to your computer and is stored on your hard drive. If you have registered with us then your computer will store an identifying cookie which will save you time each time you re-visit our site, by remembering your email address for you. You can change the settings on your browser to prevent cookies being stored on your computer without your explicit consent. GOOGLE REMARKETING
: This website uses the Google AdWords remarketing service to advertise on third party websites (including Google) to previous visitors to our site. It could mean that we advertise to previous visitors who haven’t completed a task on our site, for example using the contact form to make an enquiry. This could be in the form of an advertisement on the Google search results page, or a site in the Google Display Network. Third-party vendors, including Google, use cookies to serve ads based on someone’s past visits to our site.  Of course, any data collected will be used in accordance with our own privacy policy and Google’s privacy policy. You can set preferences for how Google advertises to you using the Google Ad Preferences page, and if you want to you can opt out of interest-based advertising entirely by cookie settings or permanently using a browser plugin. THIRD PARTY SITES My site may contain links to and from the websites of our partner networks, advertisers and other third parties. If you follow a link to any of these websites, please note that they have their own privacy policies and that we do not accept any responsibility or liability for these policies. Please check these policies before you submit any personal data to these websites. CHECKING YOUR DETAILS If you wish to verify the details you have submitted to us you may do so by contacting us via Our security procedures mean that we may request proof of identity before we reveal information. This proof of identity will take the form of your e-mail address and password submitted upon registration. You must therefore keep this information safe as you will be responsible for any action which we take in response to a request from someone using your e-mail and password. We would strongly recommend that you do not use the browser's password memory function as that would permit other people using your terminal to access your personal information. CONTACTING US We are always pleased to hear from my customers (even if it is a complaint… yes we want feedback about how we can improve!). If you have any questions or feedback about this statement, or if you would like us to stop processing your information, please do not hesitate to contact customer support at MEDIACONTACT@THESTRONGERSELFMOVEMENT.COM who will be delighted to answer any questions you may have.
ONE MORE BOX TO CHECK BELOW... We will be contacting you within 48 hours via email to set up a time to set up a FREE 10 MINUTE phone call to discuss if we are a good fit for each other and then what to do moving forward. I cannot guarantee a spot but will try my best to make one. *