1:1 Coaching Application
Name
*
First Name
Last Name
Email
*
example@example.com
Your Age
*
Weight
*
Height
*
Feet and Inches
What is your user name for MyFitnessPal.com (so I can friend you)?
What is your job?
*
Goals (Check all that apply)
*
Muscle Building
Weight Loss and Fat Loss
Strength Building
Lifestyle Change
Healthy Food Habits
1. How many hours a day do you sit?
*
Less than 2 hours
2-3 hours
4-5 hours
6-7 hours
More than 7 hours
2. Do you currently do any cardio activities? If so what is the duration of cardio each week:
*
1-2 hours
3-4 hours
5-6 hours
More than 7 hours
none
3. Do you regularly have a lifting/strength trainman regimen?
*
Yes
No
4. Do you regularly have a nutrition regimen?
*
Yes
No
If "Yes" in a few words please explain your nutrition regimen:
If "Yes", please explain your injuries or health conditions:
5. Do you have any injuries or health conditions?
*
Yes
No
6.Are you Vegan or Plant based?
*
Yes
No
7. Please list any supplements that you are currently taking:
8. What is your dieting/coaching history?
9. How often have you dieted for weight or fat loss over the last 5 years?
10. Have you tracked macros or calories before?
*
Yes
No
11. How much time do you spend walking each day?
Less than 15 minutes
15-30 minutes
30-60 minutes
More than one hour
Please verify that you are human
*
Submit
Should be Empty: