AUTHENTIC Strategic Wellness Investing Application

Thank you for your interest in AUTHENTIC

I only work with a handful of executives and leaders in AUTHENTIC each year and don't extend an invitation to everyone who applies.

This application will help me determine if I can help support your journey toward becoming a savvy wellness investor by transforming your WELL-LEADER MINDSET™ to achieve the long-term wellness you desire and if you might be a good fit for the 1-Year AUTHENTIC experience.

As such, please be thoughtful and honest when answering these questions.

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1. Please enter your personal information below. (Required.)

Name *

Time Zone

Country *

Email Address *

Phone Number *

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2. Briefly describe the current status of your health and wellness. (Required.)

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3. How long have you been struggling or unhappy with your health and wellness? (Required.)

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4. What do you believe is holding you back from achieving the health and wellness you desire? (Required.)

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5. What results do you believe you can achieve related to your health and wellness? (Required.)

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6. AUTHENTIC Wellness Advising is for ambitious, future-focused executives and leaders who are willing to step back, reflect, and think strategically about investing in their health and wellness. You must commit to making your wellness a priority, be coachable, and do the work to create, implement, and sustain your authentic Lifestyle Wellness Strategic Plan. Why do you believe you are a good fit for AUTTHENTIC? (Required.)

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7. Why do you want to coach 1-on-1 with me, Dr. Lori specifically? (Required.)

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8. How did you first "meet" me and how long have you been part of my audience? (Required.)

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9. ACTIVATE Confirmation: Should you be chosen for ACTIVATE: (Required.)

I am ready and would prefer the $19,500 pay in full option.

I am ready and can commit to 3 payments of $7,300.

I am ready and can commit to 12 monthly payments of $1,900.

I am not yet ready to invest in and make my wellness a priority.

AUTHENTIC Strategic Wellness Investing Application

Thank you for your interest in AUTHENTIC

Question Title

* 1. Please enter your personal information below. (Required.)

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* 2. Briefly describe the current status of your health and wellness. (Required.)

Question Title

* 3. How long have you been struggling or unhappy with your health and wellness? (Required.)

Question Title

* 4. What do you believe is holding you back from achieving the health and wellness you desire? (Required.)

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* 5. What results do you believe you can achieve related to your health and wellness? (Required.)

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* 7. Why do you want to coach 1-on-1 with me, Dr. Lori specifically? (Required.)

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* 8. How did you first "meet" me and how long have you been part of my audience? (Required.)

Question Title

* 9. ACTIVATE Confirmation: Should you be chosen for ACTIVATE: (Required.)

1. Please enter your personal information below. (Required.)

2. Briefly describe the current status of your health and wellness. (Required.)

3. How long have you been struggling or unhappy with your health and wellness? (Required.)

4. What do you believe is holding you back from achieving the health and wellness you desire? (Required.)

5. What results do you believe you can achieve related to your health and wellness? (Required.)

7. Why do you want to coach 1-on-1 with me, Dr. Lori specifically? (Required.)

8. How did you first "meet" me and how long have you been part of my audience? (Required.)

9. ACTIVATE Confirmation: Should you be chosen for ACTIVATE: (Required.)