COACHING APPLICATION

COACHING APPLICATION

Do you want to finally smash your health and fitness goals with me? Complete the questionnaire below!
Name*

First NameLast Name
What is your age?*
What is your height?*
(feet)'(inches)''
What is your weight?*
(lbs)
Phone*
Please enter a valid phone number.
Email*
example@example.com
Which form of contact is best to reach you at?*

Call (Morning EST)Call (Afternoon EST)Call (Early Evening EST)TextEmail
What's your Instagram handle?*
What's you Facebook name?*
Where did you hear about me?*
(e.g. Instagram, Facebook, TikTok, LinkedIn, etc.)
Did a friend refer you to me? If so, who?*
What is your current PRIORITY fitness goal?*
What are you doing to achieve this goal?*
What do you feel is holding you back from achieving this goal? (# 1 struggle)*
How many days are you currently working out weekly?*
How many days a week can you realistically see yourself dedicating to exercise?*

34567
Do you currently take any form of medication? If so, what?*
Do you have any current and/or past injuries? If so, detail below.*
Do you plan on training in a gym or from home? What equipment will you have access to if from home?*
Please as accurately as possible detail all dieting habits throughout a typical day of eating, and times. (Breakfast, lunch, dinner, snacks, supplements, and DRINKS)*
Do you often crave sugary foods?*

YesNo
Do you tend to diet poorly on weekends?*

YesNo
How often do you eat out in a week, if at all? What are your go-to choices?*
Do you smoke and/or drink? If so, what and how often?*
List some of your favorite foods.*
List some of your not so favorite foods.*
Do you have any food allergies?*

YesNo
What do you do for work or throughout the day?*
How active are you during your daily activities or job? (Sitting, standing, walking, running, physical labor, etc.)*
What are your short-term goals? (1-2 months)*
What are your long-term goals? (4-12 months)*
What has motivated you to change your life for the better and begin to work on your health and fitness?*
How committed are you to achieving your goals and making a transformation?*
What expectations do you have in regard to us working to help you achieve your goals?*
When do you want to begin your program?*
Please attach a photo of your current physique from the front.*

Cancelof
Please attach a photo of your current physique from the rear?*

Cancelof
The coaching and guidance you'll receive from my program are invaluable. For a fair cost you'll receive personalized hands-on coaching that is tailored to your specific goals and health needs. Are you ready?*

I am capable, willing and ready to commit 100% to attaining my goals!I am on a tight budget, but I will make it work for my health!I am unable to fit this into my tight budget right now.
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