Molded By Mia Online Training

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This is the first step with getting started with our training together. You'll fill out this application. After you submit the application your will be taken to a link to book your call.

During this call you will chat with me (Coach Mia) about your goals, receive a full video breakdown of how the program works, and then get you set up on an option that works best for you.

Within 1 week of signing up, you’ll be starting your new plan, workouts, and begin your nutrition coaching! Time to start seeing results and feeling confident in your own skin!

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Name* This field is required.

First Name

Last Name

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Date of birth * This field is required.

Date

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Email* This field is required.

example@example.com

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Phone Number* This field is required.

Please enter a valid phone number.

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What do you do for a living?* This field is required.

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What is your work schedule?* This field is required.Include days of the week and time of day.

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What is your instagram handle?* This field is required.Example: @moldedbymiaa

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What is your current fitness level?* This field is required.

Beginner

Intermediate

Advanced

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How often do you currently exercise?* This field is required.(e.g., times per week, duration, type of exercise)

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What is your current workout routine?* This field is required. Also list any type of physical activity you engage in.

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Do you have any experience with personal training or group classes? Or do you have any experience working out on your own?If yes, what was your experience like?

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What are your primary fitness goals?* This field is required.(e.g., weight loss, muscle gain, improved endurance, flexibility, overall health)

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Are there any specific areas of your body you want to focus on?* This field is required.(e.g., core strength, upper body, lower body)

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What does success look like to you?* This field is required. (e.g., a certain weight, lifting a specific amount, running a particular distance, eating clean consistently, working out regularly)

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What do you believe is the biggest obstacle to achieving your fitness goals?* This field is required. (e.g., lack of motivation, not knowing what workouts to do, struggling with consistency)

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Do you struggle with any specific aspects of your diet? What are the biggest challenges you face with your current diet?* This field is required.e.g., portion control, snacking, sugar intake, time constraints, cravings, emotional eating)

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Are there any situations that make it difficult for you to stick to healthy eating habits?* This field is required.(e.g., social events, work environment, cooking skills, grocery shopping)

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What obstacles do you anticipate might interfere with your fitness routine?* This field is required.(e.g., time constraints, lack of equipment, lack of motivation, feeling tired)

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What has stopped you in the past from seeing success in your fitness journey?* This field is required.

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What are you willing to do to see success in your fitness journey?* This field is required.

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Do you have any medical conditions, injuries, or concerns that impact your health or physical capabilities?* This field is required.

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Do you have a gym membership?* This field is required.

YESNO

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If yes, what gym? If no, what gym would you like to join?* This field is required.gym membership and or apartment gym is required for online training. If you do not have a gym home, I will help you find one!

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This program requires clients to workout 3-4 times a week for 1 hour. Can you accomplish this?* This field is required.

YESNO

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This program requires at least 20 weeks (4 months) of training. Would you be willing to stay in the program?* This field is required.It will take time to reach your fitness goals. I am looking for clients who are willing to put the work in!

YESNO

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Online training requires self accountability and hard work. With my guidance, could you do what is required of you?* This field is required.Examples: Completing required workouts, implementing lifestyle strategies I encourage, showing up for zoom calls..

YESNO

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Online Personal Training is an investment. Can you invest $150.00 per month into your fitness journey?* This field is required.I do offer payment plans!

YESNO

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Which payment option would you prefer?* This field is required.

$150 per month

$75 Bi-weekly

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Do you have any questions, comments, or concerns?* This field is required.This could be about anything!