Application

Thank you for your interest! You’ve taken the first step in your journey. Please complete the form below to see if we’re a good fit.

Name *

First

Last

Email *

Your best email so we can send you the zoom link

Phone *

Your cell in case we don't receive email confirmation

How did you hear about Bonnie Lefrak and the Self Made program?

Age *

What is your current weight and height? *

What is your goal weight? *

What are your goals beyond the scale? *

Why is NOW the time you have decided to get started? *

What kinds of diets or workouts have you tried to reach your goals in the past? *

If you were to be 100% honest - what do you think is stopping you from hitting your desired goals? *

On a scale from 1-10 how important is it for you to reach these goals? (1 being not important at all and a 10 being and absolute must)

Selected Value: 0

Why is now the perfect time for you to get started? *

If you're accepted to work with Bonnie and the Self Made Team how soon can you get started? IMPORTANT: If you are not ready to begin within the next 2 weeks, please do not apply at this time *

Self Made is NOT another googled diet, rather it is a program that teaches you how to lose the weight permanently and keep it off. This program is an investment in your body and wellness that will last a lifetime and save you thousands of dollars and time. How prepared are you to invest in your health, mindset, and body transformation goals? Self Made VIP is a four-figure investment. We do offer flexible payment plans. *

I have the financial resources to invest in my goals and end my struggle forever
I don’t have the resources, but I can ABSOLUTELY get resourceful! #WhereTheresAWillThereIsAWay
I don’t have the resources and I’m not willing to get resourceful

Anything else we should know?

Name