check

Apply To Schedule A Call With Tafiq

Please fill out this brief questionnaire. At the end of the questionnaire, you'll have the option to schedule a call with Tafiq on the date and time of your choosing. 

Click the button below to start.

Start

Question 1 of 24

Name?

Question 2 of 24

Email?

Question 3 of 24

Mobile Phone?

Question 4 of 24

Age?

Question 5 of 24

Are you currently experiencing any of the 3 stages of menopause: Peri-Menopause, Menopause, or Post-Menopause? 

A

Yes

B

No

C

Not sure

Question 6 of 24

If yes, are you on HRT or taking any other medication for it?

A

Yes

B

No

C

N/A

Question 7 of 24

With your job, are you primarily...

A

Sedentary

B

Active

C

I do not work and I'm pretty sedentary

D

I do not work but I'm pretty active

Question 8 of 24

Are you currently following any specific type of nutrition plan (Weight Watchers, Keto, Intermittent Fasting, etc)?

A

Yes

B

No

Question 9 of 24

If yes, which one and are you happy with your results?

Question 10 of 24

What are the TOP 3 most pressing health and wellness CHALLENGES you need help with the most? (please explain in detail)

Question 11 of 24

Are you willing to follow the nutrition, fitness, and lifestyle recommendations and coaching of a health & fitness specialist to overcome those challenges (including daily physical activity, food journaling, and consuming mostly home-cooked meals)?

A

Yes

B

No

Question 12 of 24

Do you have any injuries that would prevent you from participating in a physical fitness plan?

A

Yes

B

No

Question 13 of 24

If yes, please explain (in detail)?

Question 14 of 24

Are you married or have a significant other? 

A

Yes

B

No

Question 15 of 24

Will your spouse or significant other be supportive of you working with a coach to reach your health and fitness goals?

A

Yes

B

No

Question 16 of 24

Do you consider yourself to be overweight?

A

Yes, I'm a little overweight (need to lose 10 to 15 pounds)

B

Yes, I'm overweight (need to lose 20-30 pounds)

C

Yes, I'm very overweight (need to lose 40 or more pounds)

D

No, I'm not overweight but I need to improve my overall health and fitness.

Question 17 of 24

Some midlife health and wellness issues can take more time to heal. If needed, would you commit to a program for 6 months or longer to achieve your desired health and fitness results?

A

Yes

B

No

Question 18 of 24

On a scale from 1-10, 10 being "I'M READY LET'S DO THIS". How ready are you to commit to transforming your health?

Question 19 of 24

 If you are not at a 10, what is stopping you from being at a 10?

Question 20 of 24

Have you invested in your health and wellness in the past?

A

Yes

B

No

Question 21 of 24

If yes, what did you like AND dislike about the experience (please explain in detail)?

Question 22 of 24

What are you willing to invest in to a personalized coaching program to achieve your ultimate health and wellness goals?

A

$3499-$3999

B

$3999-$4499

C

$4499-$4999

D

$4999 - $5499

E

$5499 - $5999

Question 23 of 24

How did you hear about me and my program?

Question 24 of 24

Is there anything you'd like to add?

Confirm and Submit