Application for Nutrition/Fitness Coaching
Please answer the questions below. The purpose of this application is to make the most of our time together during our Zoom call, so please be open and honest with your responses! After reviewing this form you will get an email to set up a time to chat!
Name:
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First Name
Last Name
Email:
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example@example.com
Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
Age:
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Gender:
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Please Select
Male
Female
Height (ft & in):
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Weight (lbs):
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What is your current occupation?
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Briefly describe your initial goals (short-term):
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What are your long-term goals?
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What diets have you tried in the past, with or without success? Please describe your experience with these diets.
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What is your biggest struggle when it comes to health & fitness?
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Are you currently tracking your food or have you ever tracked your food? If yes, please describe your experience below.
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What is a typical day of eating like for you? (Please breakdown breakfast, lunch, dinner, and snacks)
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What is your current activity level / exercise routine like? Do you have access to a gym or at home equipment? If so, what type of equipment do you have?
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Do you have any current medical conditions/injuries/or are on any medications that could impact your dietary/fitness plans?
Why are you committed to working with a personal coach at this time?
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What are your top 3 questions regarding nutrition/fitness/wellness that you'd love for me to answer?
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Which day(s) of the week would work best to set up a time to talk?
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Where do you live? (Country, state - for time zone purposes)
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Which time of day would you prefer to chat?
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AM
PM
How did you hear about me?
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(i.e. Instagram, referral - who?, etc)
Submit
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