Online Coaching Application

Online Coaching Application

fill out this form the best you can, read carefully and be specific!
Personal Information
Name

First NameLast Name
Birth Date

MonthDayYear
Sex at birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Format: (000) 000-0000.
Email Address
Height
Weight
Additional Comments

Lifestyle Information
Where are you at in your lifestyle right now? Past or present challenges, future goals, or anything you want to share.
What are your main goals before starting? What made you take this step?
What is the biggest struggle you are facing with your lifestyle right now?
What do you do for work? What is your schedule like?
What is your sleep schedule like? On average, how much are your sleeping per night?
What is your current activity level? or...
see below.
average step count/day?
Sedentary
- less than 30 minutes of intentional exercise per day
  - daily activities such as mowing the lawn, going up and down the stairs, or taking out garbage do not count.
- majority of your day is spent sitting
  - ex. working an office job where you sit at your desk all-day
Lightly Active
- at least 30 minutes of intentional moderate exercise per day
- you spend a good portion of your day on your feet
Moderately Active
- 45-60 minutes of moderate exercise per day
  - shorter if the exercise is vigorous
- you spend a large portion of your day on your feet or a physical job demand
Very Active
- over 60 minutes of moderate to vigorous exercise per day
- you have a physical job demand

Health & Training Information
Where are you at in your training right now? Past challenges you've overcome, currently, future goals, or anything you want to share.
What would your rate your level of experience with working out? Have you had a trainer or coach before? Share how your experiences have been.
Where will you be working out?
if working out at home... specify what equipment you have access to or are willing to purchase.
include the weight ranges of equipment as well.
Do you have any current or past injuries that still affect you?
If yes... expand.
body part, when it happened, how it affects you, etc.
Desired Start Date

MonthDayYear
I typically need about a week to prep programs. Also consider your plans or any upcoming events that may get in the way.

Nutrition Information
Where are you at in your nutrition and eating right now? Past challenges you've overcome, currently, future goals, or anything you want to share.
Are you currently on a meal plan or tracking your meals?
If so, what does this look like for you?
Are you familiar with what macronutrients are or tracking them?
Do you have any food allergies or sensitivities?
Have you ever struggled with your relationship with food?
this can look different for everyone, any details are confidential and safe with me.
Are you currently taking any vitamins or supplements right now?
How much caffeine (mg) do you consume per day?
One cup of coffee usually contains 75-100 mg of caffeine.
Foods you prefer or enjoy...
Foods you dislike...
What nutrition guidance would you prefer?

Personal Information