Amplify Fitness & Nutrition LLC
1:1 Coaching Application
Hi! I'm so glad you're here and I'm eager to learn more about you and your fitness/nutrition goals. First off, I'd like to introduce myself- I'm 29 years old and am a Registered Nurse. I've done ICU nursing for over 7 years now, but have always had a passion for health and fitness. I decided to expand my knowledge and obtain my Personal Training and Nutrition Coach certifications through NASM in 2022. I aspire to share my passion and knowledge with my clients and help them achieve their lifestyle goals. Please answer the questions below, so I'm able to get to know you and your goals a little better. I'll reach out to you as soon as possible!
Name
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First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
*
Female
Male
Email
*
example@example.com
Age
*
Height
*
Weight
*
Activity Level
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Little to no exercise
Exercise 1-3 times/week
Exercise 4-5 times/week
Daily exercise or vigorous exercise multiple days/week
What is your main health/fitness goal?
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Lose weight
Gain muscle
Body recomposition (both options 1&2)
Healthier relationship with food and/or exercise
What has prevented you from acheiveing your health/fitness goals?
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Lack of accountability
Lack of knowledge/experience
Lack of commitment
Other
Do you have access to a gym or do you prefer home workouts?
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Gym
Home
I can do both
Do you have any diagnosed health problems or injuries I need to be aware of?
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What do you expect from me as your coach to help you accomplish your goals?
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Why do you think you would benefit from working 1:1 with me?
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Nutrition wise, what are you most interested in?
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Overall guidance and accountability
Meal plan
Macro breakdown
Healthier relationship with food
Other
Do you have any allergies or dietary restrictions?
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What does your current diet look like?
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Low-fat
Low-carb
High-protein
Vegetarian/Vegan
No special diet
How motivated are you to reach your goals?
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None
1
2
3
4
High
5
1 is None, 5 is High
What would success look like a year from now? (weight, mindset, habits, relationships, etc.)
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Are you willing to financially commit to becoming the best version of YOU?
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Yes
No
Which coaching package/program are you interested in?
Amplify Fitness
Amplify Nutrition
Amplify Fitness & Nutrition Basic
Amplify Fitness & Nutrition Premium
Unsure
Submit
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