1:1 Online Coaching Application w/ Mel
**MUST BE 18+ TO APPLY** **SERIOUS INQUIRIES ONLY** Thank you so much for being here. Before we can move onto a call, I want to know more about you and your fitness goals. What brings you here? What do you want to achieve with a coach? Are you ready to transform into the best version of yourself? Please be detailed & honest with the questions below, as the more I know, the more I can help. :)
Part 1. Basic information
Full Name
*
First Name
Last Name
Email
example@example.com
Instagram @
Gender
Male
Female
Other
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
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Year
Age
years
Height
inches
Weight
lb
Part 2. Lifestyle Information
What do you do for a living?
Whats the activity level at your job?
none(seated only)
Moderate (light activity such as walking)
High (heavy labor, very active)
Do you follow a regular working schedule, do you work days, afternoon or nights?
How often do you travel?
Rarely
A few times a year
A few times a month
Weekly
Please list the physical activities that you participate in outside of the gym and outside of work.:
Part 3. Medical and health information
If you have any diagnosed health problems list the condition(s).
If you are on any medications, please list them.
What additional therapies are being undertaken for the given health problem(s)?
If you have any injuries, please list them.
What additional therapies are being undertaken for the given injury?
Are you experiencing any stresses or motivational problems?
Yes
No
Has anyone of your immediate family developed heart disease before the age of 60?
Yes
No
Do any diseases run in your family?
Yes
No
Do you suffer from diabetes, asthma, high or low blood pressure?
Yes
No
if yes please list:
Are you a current cigarette smoker?
Yes
No
Your current diet could be best characterized as:
low-fat
low-carb
high-protein
Vegetarian/Vegan
No special diet
If you’re following macronutrients, what are they currently?
Part 4. Goals
Please rate your readiness for change.
1
2
3
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9
10
What following goals does best fit in with your goals?
Improved health
Improved endurance
Increased strength
Increased muscle mass
Fat loss
What is your goal with your training?
Why?
How often are you willing to train a week to reach your goal?
Please rate your motivational level to do what it takes for reach your goal.
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2
3
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10
Are you currently excersising regulary (at least 3x per week)?
Yes
No
Other
Have you ever worked with a coach?
Yes
No
If so, why did you stop working with them:
At what times during the day, do you you usually train?
Morning
Mid-Day
Afternoon
Evening
Please Select
1 Session
2 Sessions
3 Sessions
4 Sessions
5 Sessions
6 Sessions
7 Sessions
Please Choose
What are your expectations of me as your coach?
Please give me 24-48 hours to get back to your application. Thank you for inquiring. :-)
Submit
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