Nutritional Coaching Application
Sovereign Strength Society
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
Ex. 08/01/1995
Height & Weight
*
Ex. 5'5" 160 lbs
Occupation
*
Is your job
*
Sedentary
Moderate Activity
Active
Preferred Check-In Day
*
Monday
Tuesday
Wednesday
Other
Training Experience
*
Brief description of current/past cardio/weights/classes/etc.
Health & Fitness Goals
*
Lose weight, add muscle, etc.
Do you have access to a gym? If so, where?
*
If home gym, please list available equipment.
Have you ever tracked your diet or macros?
*
Yes
No
How many days per week can you devote to exercise?
*
1-3 days
5 days
7 days
I'm not interested in exercise.
How much sleep do you get on average?
*
Ex. 5-6 hours, 7+, etc.
My social life consists of:
*
I have lots of free time.
I party multiple times a week.
I don't have time for a social life.
My family is my social life
My support systems consists of:
*
Ex: Live by myself, bf/bf works out as well, live with roommates that are not into health/fitness, etc
Are you currently on or foresee being on any medications?
*
Any food allergies?
*
Any injuries or medical drawbacks that will prevent you from exercising?
*
Disclaimer: Sovereign Strength Society and it's coaches are not qualified medical professionals or licensed physicians. We are not qualified to treat or coach with clients who have current or non-treated eating disorders or undiagnosed disorders that should seek a physician's review. Do you understand and agree that you are of sound body and mind to receive coaching?
*
Yes
No
My Products
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Monthly Coaching - MOST POPULAR
Purposed around longevity and modifying your diet to match your goals based on current lifestyle.
$
125.00
Quantity
1
2
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10
8 Week Shred
Quick and controlled diet to attack stubborn pounds. Good for those preparing for an event.
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
12 Week Transformation
Intense dive into existing diet. Requires most focus and dedication for optimum results.
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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