Coaching Application

Coaching Application

Lift Heavier - Feel Lighter
Name

First NameLast Name
Email
example@example.com
Where are you Located?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Current Occupation
Instagram Handle @:
What are your current fitness and nutrition goals? (Choose any that apply)

Weight LossGain Lean MuscleToneBody RecompositionSpecial Occasion (i.e. wedding)Improve overall health and/or lifestyleDevelop a positive relationship with foodGain confidenceCreate healthy habitsReverse DietingOther
Why have you chosen to start your fitness journey today?
What has held you back from previously obtaining your goals?
What type of support do you have to reach your goals?

How committed are you to reaching your goals?

	1	2	3	4	5	6	7	8	9	10

1 is Not Committed, 10 is Very Committed

Describe a current day of eating (breakfast, lunch, dinner, snacks)
I understand that my nutrition will play an intricate part in reaching my fitness goals therefore, I am willing to address/change my nutrition as a part of this process.

YesNo
Where do you want to see yourself in the next 3 months, 6 months, 1 year?
Why do you want to work with me?
When do you want to begin your fitness journey?

MonthDayYear
Date
If you are working out at home, what equipment do you have?
Any other information you would like to share?
Phone Consultation Request
Should be Empty: