First Name
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Last Name
*
Email
*
Date
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How many hours sleep per night on average have you had since your last check-in?
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Less that 5
5-7
7-9
9+
On a scale of 1 to 10, how has your stress been on average since your last check-in (1 = Not stressed, 10 = Very stressed)?
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1
2
3
4
5
6
7
8
9
10
Tell me something good that happened with your program.
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Tell me something not so good that you want to improve upon with your program.
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Do you have any major life events coming up?
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Do you have any major lifestyle changes I need to know about?
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Is there anything with your plan you think needs changing?
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What goals are still unmet at the end of this month?
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What goal will you set for the next month?
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By providing your phone number, you consent to receive text messages and phone calls from Level Up Your Life Pty Ltd, including its brands Loz Life and The Mojo Mentor. These communications may include automated, pre-recorded, or AI-generated voice messages. You consent to receive marketing communications from us, including updates, promotional offers, and information about our programs and services. Message and data rates may apply. You may opt out of text messages at any time by replying STOP or contacting us directly. You may opt out of calls by letting us know during a call or by emailing team@lozlife.com . Important Note: These requirements reflect common legal standards, but laws may vary by jurisdiction. You are responsible for ensuring that your consent language complies with all applicable laws. We recommend reviewing this language with qualified legal counsel before use.
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