Coaching Application Form

1

What best describes your current health & fitness situation?

I feel tired, run down, and not like myself

I struggle with consistency around food, training, or routine

I’m doing “all the right things” but not seeing results

I feel okay, but know I could be operating at a higher level

Other

2

What do you WANT to improve most right now?

Energy levels & daily performance

Relationship with food

Strength, fitness & body composition

Confidence in my body

Overall health & lifestyle balance

Other

3

What’s been your biggest challenge?

I can’t stay consistent long term

I don’t have a structured plan that works for me

I feel overwhelmed with conflicting information

My lifestyle (work, stress, family) gets in the way

I’ve tried things before but nothing sticks

Other

4

How long have you been dealing with this?

A few months

6-12 months

1-3 years

Honestly...for years and I'm over it

5

How is this currently impacting your life?

Low energy / constantly tired

Lack of confidence in my body

Frustration with not progressing

Feeling out of control with food or routine

It’s affecting multiple areas of my life

6

How serious are you about improving your health right now?

I’m ready to fix this immediately

Within the next 30 days

Soon, but not urgent

Just exploring

7

Have you tried to solve this before?

Yes — multiple times, no lasting success

Yes — some success but couldn’t maintain it

No, this is my first serious attempt

8

If you found the right coach & system, what would you do?

Start immediately

Ask a few questions then start

Think about it

Probably not ready

9

Are you willing to invest in long-term results (not quick fixes)?

Yes — I want something sustainable

Depends on what’s included

Not sure yet

10

Name

First Name

Last Name

11

Email

example@example.com

12

Phone Number

Please enter a valid phone number.

13

Instagram handle

14

What made you apply today?

15

What would your ideal result look like in 3-6 months?

16

What happens if nothing changes?

17

On a scale of 1–10, how committed are you to improving your health right now?

1–4 (not very committed)

5–7 (somewhat committed)

8–10 (fully committed)

18

If accepted, are you ready to start within the next 14 days?

Yes — ready to go

Need a bit more info first

Not ready yet

19

Is there anything that could stop you from committing if it’s the right fit?