Online Coaching Inquiry
Thank you for showing interest in customized fitness and nutrition coaching with me. Please answer the questions below as accurately as possible and I will be in touch via email within 24 hours to set up a consultation call.
Name
First Name
Last Name
E-mail
Phone Number
-
Area Code
Phone Number
Birth Date
*
Please select a month
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Month
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Day
Please select a year
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Year
Height (inches)
Weight (lbs)
How active are you currently?
What would you like to accomplish in training?
List all previous or current injuries and any areas that cause limitations or pain
Describe a typical working day (wake time, all meal choices, training. social and bed time)
Describe what your current fitness and nutrition regimen looks like
Describe what goal/s you hope to achieve with working with me
What are your biggest obstacles with achieving these goals? Please list all that apply.
How will you feel once you achieve these goals? How will it impact your life?
What is your long term goal?
What have you attempted previously to achieve your health and fitness goals?
On a scale of 1-10, how important is it for you to achieve your health/ fitness goals?
How would you describe your current attitude towards fitness in general?
List all equipment that you have access to
What activities do you enjoy? Select all that apply
Past/ Current Eating Habits
What are your current eating habits like?
Eat healthy the majority of the time with the occasional treat
Trying to eat healthy but don't always know what is healthy and what isn't
Eat less nutritious food and don't cook very often
No idea what I'm doing when it comes to nutrition
On a scale of 1-10, how good would you say your knowledge of nutrition is? 1- I'm clueless and 10- I know what I need to be eating to reach my goal
Have you had experience counting macros or tracking your food?
Yes
No
List any dietary restrictions or concerns
Sleep and Stress
How many hours of sleep do you get each night?
How active is your job/ daily life?
Sit at a desk all day
At desk and also on feet
Always on your feet
Physical labor
Other
Accountability
Are you willing to complete weekly check ins, discuss progress and challenges, share body measurements and physique photos and stay on top of your training?
Yes
No
Maybe
Are you willing to work with me for a minimum of 3 months?
Yes
No
Maybe
Do you have any medical conditions or injuries that will affect your online coaching?
How did you hear about me?
Submit
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