Full Name
*
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Last Name
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*
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Year
Age
years
Height
in
Weight
lb
Instagram
What are your goals? *
Fat Loss
Weight Training -
Strength Building
Lifestyle & mindset change
Reverse Diet
Other
What is the #1 goal you would like to accomplish in the next 6-12 weeks? What do you want to change about your body, your mind, and your lifestyle?
What's the reason you haven't been successful in the past with your goals?
If I was able to help you reach these goals, how would you feel 3 months from now? How would your life and happiness change?
Give me a layout of your current diet & workout situation. Are you tracking macros/calories? Are you on a specific workout plan, or are you working out at all?
My coaching packages start at a few hundred dollars a month. If we both feel like it's an absolute YES to work together, are you able to put down the financial investment required to hire a coach?
Heck yes
Maybe in the Future
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
Please list the physical activities that you participate in outside of the gym and outside of work.:
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
Do any diseases run in your family?
Yes
No
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
TImeline for achieving your goal.
8 WKS
16 WKS
24 WKS
32 WKS
40 WKS
1 YEAR
NOW
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