Step 2: Before your Breakthrough : Provide Info

Using the images above please estimate your current body fat percengate *

In terms of body fat where do you want to be a year from now? *

Age As Of Today *

Height *

What is your current weight? *

Belly Line Circumferenece *

Time Goals & Commtiment

What is your health aspiration for 90-Days (Your Goal Weight in 90 days)? *

What is your weight aspiration for 6 months from now? *

What is your ultimate weight aspiration (goal)? *

At This Point In Your Life: How Much Time Can You Realistically Commit To Your Health Journey On A Daily Basis? *

15 Minutes/Day

30 Minutes/Day

60 Minutes/Day

Symptoms and Challenges

Which Symptoms Are Bothering You The Most *

When it comes to reclaiming your healthy body, what's your biggest challenges? *

Pricing Transparency

1-1 Support and Guidance from a Hormone Specialist is not "cheap." Guaranteed Results are priced accordingly.

In Case Your Decide To Enroll After Your Breakthrough Session - Which Pathway Are You Most Interested In? *

Group Coaching $99/month

1-1 with App $249/month

True Results Guaranteed Directly 1-1 w/ Coach Tom

I am open to the option that is best for me

Are you willing to invest in yourself (physically, financially and emotionally)? *

Do you have the ULTIMATE decision making power over you own health and well-being? Or do you need someone else's permission (Spouse, Parent, Dr., etc.) *

I have the power to decide

My Spouse will join us for the Breakthrough Meeting (I need their permission)

Picture and Contact Info

Most Important Data
A picture of your current body-health state is worth 1000 words.
It needn't be fancy - just current. If you don't want someone to take it for you just take selfie pictures of yourself in the mirror and upload here.

Side-Facing (Starting Data) Photo From Thighs To Head

First progress picture. Please take and u

Side-facing

Front-facing picture that shows your body shape from thighs to head so I can determine your metabolic somatotype.

Please upload a jpg, jpeg or png file from your phone that shows your upper torso today

Full Name *

Email *

Phone *

Our objective is to help you "Lighten Up" for life. Mind/Body/Hormones/Neuroepigenetics

Note: If form doesn't submit please ensure that you have filled out all of the required fields and then push submit again. If a field is highlighted in red your input is missing or invalid.

Congratulations Your Breakthrough Session Is Scheduled

Pre-Breakthrough Homework

Use the pictures below to estimate your body fat %.