CUTZ&GAINZ EXTREME COACHING CONSULTATION FORM
What do you do for a living (title or occupation ) ?
Are you a business owner ?
Does your job require you to look a certain way ? (yes or no)
do you have 50+ pounds to lose ?
Do you travel a lot for work ? (yes or no)
Where would you like to see yourself in 12 months business/financial wise ?
Where would you like to see yourself in 12-16 weeks physically ?
Do you consider yourself coachable ?
Do you understand that this program is for people who need 1-1 custom coaching ?
why do you feel you can never hit your goals is it you or the system ?
what issues do you have when it comes to finding time to exercise ?
How many times have you attempted to lose weight in the past ?
*
1 to 2
3 to 4
5 +
Are you married ?
*
Yes
No
Do you have kids ?
*
Yes
No
Do you drink (alcohol )
*
Yes
No
How many times a day do you eat?
*
1 to 2
3 to 4
5 to 6
How many hours do you sleep a night ?
*
More than 6
Less than 6
do you have any medical conditions diabetes , blood pressure etc ? (list them )
On a scale of 1-10 how mentally ready are you to getting healthy and in shape ?
Do you have food allergies (list them) ?
Do you have any past physical injuries ?
Yes
No
Would you like to better some of your underlying health conditions ?
*
Yes
No
Do you Feel that coach carl has what it takes to help you reach your goal ?
I'm Carl the guy in the picture, "Would you like me to contact you for a Free Weight Loss Consultation"?
*
Yes
No
what time works best for you ( after 4pm Atlantic time) ?
Name
*
First Name
Last Name
Age
*
Gender
*
Weight
*
Height
*
Activity Level
Exercise 1 to 3 times per week
Exercise 3 to 5 times per week
Exercise 6 to 7 times per week
E-mail
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Submit
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