APPLICATION FORM Name * First Name Last Name Email * What do you do for work? What is your business? * How many hours per week do you work? * What are your current health practices? (regular walking, exercise, taking vitamins, eating a balanced diet, 7+ hours of sleep/night, meditation, drinking enough water) * What are you currently struggling with health wise? (Please check all that apply) * Poor digestion Brain fog Headaches Back/shoulder/neck pain Inconsistent energy during the day (10am/3pm crashes) Unmotivated at work Tired all the time Trouble sleeping at night Unable to cope with stress like you used to Anxiety Waking up tired How long have you been feeling like this? * How do you think your life & business would be different if you woke up clear, energized and healthy everyday? * Why do you feel drawn to work with Jordan? * Do you have any questions for Jordan? * Which payment option would you like Jordan to send over? 3 months of coaching - I will pay $3k in full 3 months of coaching - I will pay 3 monthly payments of $1k 6 months of coaching - I will pay $5,500 in full 6 months of coaching - I will pay 6 monthly payments of $916 I'm interested in a Health Strategy Session - $350 Congratulations, you’ve taken the first step! Go grab a drink of water, take a deep breath and take a moment for yourself. You can expect he hear back from me within 2 business days.xo, JC
