Assessment Form

You're One Step Away From Real Change

Please fill out the form below so we can understand exactly where you're feeling stuck.

Once submitted, schedule your free goal-setting call with Corry—your chance to get expert guidance, ask questions, and finally start seeing real progress.

💡 Nothing changes if nothing changes. Take this step today, and let’s talk about what’s possible for you.

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Full Name *

Email *

Phone - mobile *

Zip Code *

Referred By / How'd You Find Us? *

Birthdate (please use the calendar to select your date of birth YYYY-MM-DD)

Height

Current Weight

Do you have any medical conditions/concerns, allergies, medications that you need to discuss on our call? If you don't wish to list them here, simply answer yes.

List your goals and WHY you want to achieve them. What would it mean to you if you were able to finally reach your goals?

What time do you wake up? Go to sleep?

Describe your daily committments - work, home, family?

How many days a week do you currently exercise? Where do you exercise? What type of exercise do you enjoy most?

Tell us about your nutrition. How often do you eat? What are your go to foods? What foods do you like/dislike? And what is your biggest challenge when it comes to eating healthy?

Please verify your request. *

CONSENT/WAIVER: By clicking SUBMIT below, I hereby release in full and forever discharge and hold harmless Strength & Grace Fitness, LLC, CatKlaw, Inc., and their officers, owners, contractors, and employees, whether acting within the scope of their employment or otherwise, from any and all liability, loss, cost, damage, expense, claim, or suit whatsoever for any injury, illness, or harm arising from or in any way related to my participation in the Hormone Solution or 21-Day Detox programs. I understand that these programs are intended for educational and wellness support purposes only. They do not diagnose, treat, or cure any medical condition, and do not replace medical advice from a licensed healthcare provider. I acknowledge that any lifestyle, movement, mindset, or supplement suggestions made are optional, and I accept full responsibility for my choices and results. I confirm that I am participating voluntarily and have disclosed any relevant medical conditions or medications where applicable. I understand it is my responsibility to consult with a physician before making any significant changes to my health regimen. I have read the program materials and answered all intake questions truthfully and completely. I understand that results may vary, and no specific outcome is guaranteed. By submitting this form, I agree to these terms and voluntarily participate in the programs offered by Strength & Grace Fitness, LLC. *

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Assessment Form

You're One Step Away From Real Change

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