The Rebuilt Man Academy

Fitness Coaching Application Form

For ambitious recently divorced men ready to finally break through plateaus, lean out, and see visible muscle definition by optimizing your metabolism and mindset. This is for the men who have tried it all and feel like they're doing everything right, but have little results to show for it. Due to high demand, you must qualify!

“You’re not starting over, you’re rebuilding stronger.”

First Name *

Last Name

Email *

Phone *

Age *

Please note: we do not work with anyone under the age of 21

What is your primary goal? *

What have you been struggling with on your own to achieve this goal? How long have you been struggling with this? *

What do you do for work? *

On a scale of 1-10, with 1 being I am content with my current body and health and 10 being I need to make a change now, where do you fall? *

If everything aligns and you love the plan we lay out for you—are you ready to take action right away? If you are not ready please wait to schedule a time when you are! *

If we are able to find a way to achieve your desired goals by working with us, would you be willing (and able) to invest in getting the help necessary to get there? *

Have you ever invested in your health before? If so, how much have you invested?

If selected, you’ll be directed to our calendar to book a strategy call with a member of our team. On that call, we’ll walk through your goals and map out a personalized plan designed specifically for your body, lifestyle, and long-term success.

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