Training Application Form

Coaching Application

Personalized Training and Nutrition
Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Phone Number

In general, what are your goals? (describe all that apply)

Have you tried any diets in the past to change your health, your eating and/for your body? If so, please tell me what you have tried in the past.

If you answered YES what was it about those diets or plans that worked well for you?

Elevate any changes to your habits, diet or workout routine within the last month? If so, please tell me what you have tried in the past.

Please list ALL of your concerns about your health, eating habits, fitness, body or body image that you may have.

Please describe your household, family, pets, routine, roommates, etc

On a scale of 1-10 (1 being low) how much do the people around you support your fitness goals?

What is your current frequency/duration of workout routine?

Please detail any known exercise activities that I should be aware of. IE: dog walks, yard work, strenuous activity at work..

Please detail your daily schedule for the week and what your weekends look like

DO you travel for work(if yes, how long and and often do you travel?) work night shift? On a scale of 1-10 how do you feel about your use of time, free time and schedule?

What are your TOP 3 activities/experiences/situations that bring YOU the MOST JOY to your day or week?

Do you have any food preferences/adversions? Does what you currently eat satisfy your hunger? On a scale of 1-10 how would you rate your hunger on a daily basis?

What does your sleep currently look like? How many hours do you manage to get and on a scale of 1-10 how would you rate your quality of sleep?

What does your digestion look like? Do you have any gas, constipation, indigestion or bloat? Do you feel under stress?

If you do feel stressed how do you cope with your stress? What are your TOP 5 favorite activities to manage your stress?

What do you expect from me as your coach and WHAT are you prepared to do to work toward your goals?

Is there anything else you want me to know about you, your health journey to date and your goals?

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