Who you are?

First name

City

State

How old are you?

Are you currently:

Working

Self-Employed

Unemployed

If working, what do you do?

Do you have children?

If so, how many children and ages?

What does your current daily routine look like?

How would you describe your life right now in ONE word?

Mindset & Emotional Check-In

How have you been feeling emotionally over the last 30 days?

What has been weighing on you the most lately?

Do you feel supported in your current life? Why or why not?

What is something you’ve been silently struggling with?

What does “peace” look like for you?

When was the last time you truly felt happy? What were you doing?

Do you feel like you’ve been pouring into yourself? Explain.

Financial Reality

On a scale of 1–10, how would you rate your current financial situation?

What is your biggest financial stress right now?

Do you currently budget your money?

Yes

What is one habit you know is hurting you financially?

What would financial freedom look like for you personally?

Lifestyle & Environment

What area of your home needs the most attention right now?

Do you feel your environment reflects the life you want?

What is one thing in your space you need to let go of?

What daily habit is currently draining your energy?

How organized do you feel your life currently is (1–10)?

Health & Physical Glow Up

What is your current weight?

What are your top 3 fitness or health goals?

How often are you currently working out?

What does your current eating routine look like?

What is ONE physical change you are committed to making in the next 21 days?

Glow Up Commitment

Why did you join the Glow Up Series?

What are your TOP 3 goals for the next 21 days?

What has stopped you from reaching these goals before?

On a scale of 1–10, how committed are you to this Glow Up?

What would your life look like if you actually stayed consistent?

What kind of accountability do you need from this group?

Are you open to being challenged and pushed outside your comfort zone?

What does your “soft life” look like in detail?

Finish this sentence: “By the end of these 21 days, I will be __________.”