Free 20min Consultation – Mike Ferrer

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Your Name *

Your Mobile *

Your Email *

GenderMaleFemale

Age

Height (Cm)

Weight (Kg)

I live a high stress lifeYesNo

My energy levels drop / get tired quicklyYesI get tired earlier than I used toNo, full battery all day

I take meds daily1 or 2 /day3 or more /dayNot taking any meds.

I have taken a magnesium supplement in the past 24 hoursYesNo

I have taken a supplement (not magnesium) in the past 24 hoursYesNo

My blood pressure isNot great, I take meds for itA little off but no medsPerfect, no meds.

I experience chronic illness, inflammation or have mobility issuesYes - affects my day to dayA little bitNo issues

I experience brain fog / memory lapse / hard to focusYes - affect my day to dayA little bitNo

I experience panic / freeze / confused / angry / impatient / burstingYes - affects my day to dayA little bitNo

I get this many hours of sleep on an average night5 or less6 to 77 or more

The quality of my sleep isGreat, and I rarely wake up through the nightOK, but I toss and turn, wake or get up in the nightI am tired in the mornings and don't get a good night's sleep

I work out2 or less times/wk3 to 4 /wk5 or more /wk

How many Lbs would you like to drop?up to 1010-2020 or more

My overall healthI need to get healthier asapCould improve a littleMy health is excellent

My ideal body type (for myself) isThin / SlimAthletic / MuscularBig & Strong (Men) // Curvy (Women)The body type you'd like to achieve

What are you hoping to achieve?

What have stopped you from getting what you want - so far?

Add me to your community & mailer *Yes

I confirm that I am in good general health and do not have any medical restrictions. *Yes

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