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All-Access VIP Coaching Application
by Heather Binns of Renov8 Fitness
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1
What is your name?
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First Name
Last Name
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2
Date of Birth
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Date
Year
Month
Day
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3
Biological Sex
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Please Select
Male
Female
Please Select
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Male
Female
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4
What is your email address?
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example@example.com
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5
Where are you located (city, state, country)?
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6
What is your phone number?
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Please enter a valid phone number.
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7
How did you hear about Renov8 Fitness?
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8
Do you want to retain all of your functionality as you continue to age?
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YES
NO
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9
Are you committed to making time for your health at least 5 minutes a day?
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YES
NO
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10
What is your desired 12-month health & fitness goal?
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11
How long have you been trying to reach this goal(s)?
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12
What are some of the challenges you face in getting to where you want to be?
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13
Why are you reaching out now to solve this issue/attain this goal?
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14
Why do you feel you haven't solved this challenge on your own?
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15
What is your support system like at home for your health & fitness journey?
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16
On a scale of 1 to 5, how much support would you want from your coach (i.e. how much access do you want to your coach) so you can successfully reach your goals?
*
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1 = I don't need a lot of communication with my coach. I'm a self-starter, and I'm fine being coached in a group setting. I just want to be told what to do and will do it on my own.
3 = I'm totally cool with talking to my coach periodically via the provided platforms.
5 = I want unlimited access to my coach and to have them in my back pocket. At this stage in my life, I need a lot of hand-holding.
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17
On a scale of 1 to 10, how committed are you to reaching these goals and creating your new healthy lifestyle?
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1 = I'm not committed
4 = I'm one foot in, one foot out and will probably keep doing the same as today
8 = I'm mostly committed
10 = I'll do whatever it takes to make this happen. I'll invest time, money & resources to make myself a priority and to turn my life around!
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18
If you answered anything less than 10, what would have to shift for you to make yourself a priority and choose 10 out of 10?
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19
If you answered 10, what's one thing you can do TODAY to get momentum rolling in this direction?
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20
How do you prefer to workout?
1. On your own at your convenience
2. In a semi-private small group setting
BOTH on my own at my own convenience AND in a semi-private small group setting
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21
Do you currently have a consistent income from one or more sources, or have the willingness and financial stability to invest in yourself at the four-figure level annually?
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YES
NO
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