WELLNESS GROUP COACHING
with Coach Chelsea
Please fill out this form and I will get back to you with more information and next steps! I will help you choose the workouts and nutrition plans that are best suited for your goals - whether you want to burn fat, increase metabolism or build strength & endurance, we have a workout for you! I will also be walking you through a nutrition plan, recipes and meal prepping to maximize your results. We will also be tapping into topics such as why eating "healthy" doesn't always equal results. You can also expect mindset and personal development work to enhance your fitness journey! I look forward to hearing from you soon.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Social Media handles
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Enrollment Information
Why do you want to be a part of this coaching group? Why do you want to make the commitment to yourself and me as your coach?
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Health & Lifestyle Questionaire
Do you feel you receive balanced nutrition from the foods that you eat?
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No
Yes
How would you describe your energy levels?
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Ok
Up & Down
Lethargic
Excellent
Would you like to improve your energy levels?
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Yes
No
Would you like to: (choose whats applicable for you)
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Lose Weight
Reduce Body Fat
Gain Muscle
Maintain weight
Improve general wellbeing
Learn more about food/nutrition
Conquer stress and emotional eating
Find more ME time
Feel confident
Get shredded!
What is the hardest part about healthy eating and exercise for you?
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Do you exercise
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Not at all
Occasionally
Regularly
If so, how do you like to move your body?
Please Select
Walking
Running
Gym
Yoga
Pilates
Swim
Cycle
Dance
Team Sport
Barre
Golf
Other
What have you "tried before" that hasn't worked to reach your goals?
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Would you like to improve your sports performance/strength/endurance?
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Yes
No
On a scale of 1-10 (1=Not at all) + (10=I want it yesterday) how motivated or serious are you about reaching your goals as this time?
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1
2
3
4
5
6
7
8
9
10
WORST
BEST
1 is WORST, 10 is BEST
How can I most help you as a coach?
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Medical Information
Do you suffer from any health issues? (i.e, asthma, allergies, diabetes, blood pressure, cholesterol, arthritis, musculoskeletal injuries, other?
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Please provide and explain.
Please review the following check list
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Rows
YES
NO
Do you smoke?
Drink Coffee or Coffee Drinks?
Drink energy drinks
Drink soft drinks
Do you eat breakfast?
Do you get at least 6-8hrs sleep
Do you drink at least 2L water
Do you eat take away food?
Do you eat fast food?
Crave sugar
Crave salt
Are you willing to commit to 30 days of making your health and wellness a priority while being coached by me? Are you willing to commit to checking in with me daily as your coach?
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How did you hear about this awesome group? Please be specific.
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