COACHING APPLICATION FORM
Please complete the form in as much detail as possible. Completion of Application does not guarantee placement.
CLIENT PROFILE
PLEASE UPLOAD AN IMAGE OF YOURSELF
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FULL NAME
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First Name
Last Name
AGE
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EMAIL
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example@example.com
Phone Number
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-
Area Code
Phone Number
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WHAT ARE YOUR GOALS?
Please list your goals, be as specific as possible. The more information I get the better understanding I have to help you.
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If you have any, what are your specific time frames for achieving your goals?
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In your best week how many days can you commit to working out?
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Is there anything else you want to share about your fitness, training or nutrition goals?
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What is the biggest thing preventing you from achieving your fitness goals?
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Kindly elaborate on why you believe you should be considered as a potential client, and indicate your level of commitment
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MEDICAL
Any limitations I should know about? (injuries, food allergies, doctors orders ect)
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Are you on any medication? (FEMALES: This includes birth control)
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Do you have any medical issues I need to be aware of? Do you have autoimmune disorders, IBD, IBS, GERD, acid reflux, Colitis, gall bladder, SIBO type issues?
Autoimmune disorders
IBD
IBS
GERD
Acid reflux
Colitis
Gall bladder issues
SIBO
PCOS
Other
IF OTHER PLEASE STATE
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IN-PERSON PERSONAL TRAINING
Mark all days/times you're likely to be available for Personal Training Sessions, a rough guess is fine. Session duration is 1 hour.
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08:30
09:00
09:30
10:00
10:30
11:00
11:30
12:00
12:30
13:00
13:30
14:00
14:30
15:00
15:30
16:00
16:30
17:00
17:30
18:00
18:30
19:00
MONDAYS
TUESDAYS
WEDNESDAYS
THURSDAYS
FRIDAYS
If you were referred please state the name of the individual who referred you.
First Name
Last Name
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