Merrin Francis Health Coaching Application
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Age
Referral Source
Tell me about your current health and fitness goals and what you are trying to accomplish.
Are you currently taking actions toward your fitness goals?
Have you worked with a coach before? If so, how many times?
Have you ever tracked macros or portion sizes? Are you open to either of these tracking methods?
What services are you interested in:
Macros only
Meal plan only
Portion control only
Training only
Training and nutrition
Briefly describe your current workout routine, including how often and types of exercise.
How would you describe your current relationship with food and your body?
What is currently your biggest struggle with achieving your goals on your own?
On a scale of 1-10, how ready are you to make changes to reach your goals? 10 being the most ready.
On a scale of 1-10, how confident are you that you can make these changes to reach your goals? 10 is most confident.
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