I'm so happy you decided to take this next step!
I’m currently reviewing applications for women who want structure, support, and a real system to stay consistent with their goals. This form helps me understand where you’re at right now so I can see if my program is the right fit for you.

Please answer every question honestly and with detail — incomplete forms won’t be reviewed.

Once you submit, you’ll be able to book your call if your application is approved!

Talk soon, love.

First Name *

Last Name *

Phone *

Email *

What’s your current occupation? *

Where are you located? *

Age? *

18 - 24
25 - 31
32 - 44
45 +
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Which of these feels most like you right now? *

I stress-eat or crave sweets after long, busy days.

I keep spending money eating out because I don’t plan my meals.

I keep starting over because I can’t stay consistent.

All of the above.

What’s your biggest goal over the next 3–6 months? *

6. How often do you eat out or order takeout in a typical week? (multiple choice) *

Every day

A few times a week

Once a week or less

Rarely — I mostly cook at home

When do you want to start seeing real results from a structured system? *

ASAP — I’m ready to start!

Within the next 2–4 weeks.

I’m just exploring my options for later.

If accepted, how ready are you to invest your time, energy, and finances into a coaching program designed for long-term success? *

I’m fully ready — this is my priority right now.

I’m serious but need to plan my budget.

I’m not ready yet — I just want to learn more.

My coaching system requires a real investment to see results. Which range best matches what you’re comfortable committing to your goals? *

Under $1,000
$1,500–$3,000
$3,000–$5,000+
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By checking this box, I agree to receive emails and text messages from Akima regarding my appointments, account updates, and occasional promotions.