Client Application Form

Welcome to my Client Application Form! I'm excited to have the opportunity to work 1:1 with you! Click next to get started!

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What's your Full Name?

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What's your age?

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Whats the best number to reach you at?

Area Code

Phone Number

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What's your email?

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Where are you located?

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What's your height?

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Whats your current weight? (Pounds)

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Whats your number one struggle right now and how has it been holding you back from achieving your goals? How long have you been struggling with this?

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Where do you usually train?

Gym

Home

Home because of COVID 19

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How many steps do you average a day?

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Current nutrition regime (how you go about eating in a day/week). With this, I want you to be honest with both me and yourself. This is a judgement free zone. This information won’t be shared with anyone but me! Share with me what a Full Day of Eating looks like.

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Where do you usually eat out?

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Do you smoke regularly?

Yes

No

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Do you drink alcohol regularly?

Yes

No

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What do you do for work?

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What is your WHY and PURPOSE for wanting to make these changes to your health and lifestyle?

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What are your short term (1-3 months) and long term (4-12 months) goals? Do you have a goal weight in mind? The more specific you are the better!

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Why do you want to work with me? My coaching program is not a cheap cookie cutter, or one size fits all program. Its one on one coaching that is geared towards your specific goals and needs. Are you willing to invest in my coaching if you feel its needed?

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Do you have any other questions or want to tell me anything else about you?