Alchemical Mastery Application Form

What is your name? *

What is your phone number?

What is your email address? *

Where did you first hear about my coaching program? *

What is your occupation? *

What is your age? *

What is your current weight and body fat %? *

How long have you been weight training?

In years.

Are you currently using TRT/HRT?

Yes
No

If yes, what is your current TRT/HRT delivery method?

Leave this field blank if you are not using TRT/HRT.

What is your dosage?

Leave this field blank if you are not using TRT/HRT.

What supplements/medications are you currently using?

What were the results of your most recent bloodwork?

Do you feel like you need help? *

Yes, help is essential
Yes, it would be nice to have help
Maybe, I'm not sure
No, I can do this myself

What are your goals?

Be specific—it doesn't have to be a goal related to your physical body. Anything from "lose 20 pounds" to "overcome depression" to "get ripped" is a good answer.

What have you tried in the past? Why hasn't it worked? What's stopping you from hitting your goal? *

What would be the most important criteria for your success as we work together?

On a scale of 1–10, where 1 is "I'm satisfied where I am" and 10 is "I'll do anything to reach my goal NOW," what number are you? *

Are you willing to make a financial commitment to your health and fitness goals?

Does your spouse or significant other support you? *

Yes, they're with me every step of the way
No, they don't really care one way or another
No, they actively oppose my goals
This question doesn't apply to me

What would you expect from me as your coach if we decide to work together? *

Space is very limited and I want to make sure this is a good fit. Why do you think you would benefit from a call, assuming you're invited? *

My programs are about teaching, not just ordering you around. I tell clients It's a one time investment. I'm not the cheapest but I solve your issue forever. After the program you should never need another coach or program again because I'll teach you every last trick in the book pertaining to diet and exercise. With that said, are you willing to work hard, invest both time and finances plus be coachable to reach your goals? (Be ready to move forward on the call IF YOU and me decide you're a good fit for this program. IF you are not a good fit I will let you know and refer you to someone else) *

If accepted how soon are you looking to get started? (if you aren't ready please just wait and schedule when you can. I expect those who feel it's a fit to move forward. Those who don't take actions are 95% more likely to continue to do nothing) *

Will you show up on time? If not don't waste my time.* I have a family just like you, value my time. Show up at the time you pick. *

If you're ready to begin, click "Submit" to pay for your 30-minute consultation with Jay via PayPal.

Price: $ 499.99

This one-time fee is fully-refundable towards your coaching program, should we decide to work with each other. In all other scenarios (including if you miss our scheduled call or opt not to work with me), this fee is non-refundable.