Client Application Form
Name
*
First Name
Last Name
Age
*
Email
*
example@example.com
Instagram Handle
*
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
What is your main goal? (Check all that apply)
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Fat loss
Build muscle
Reverse dieting
Better relationship with food
Tell me about the most important goal you’d like to accomplish in the next 3-6 months: What do you want to change about your body, your health, your mindset and your lifestyle?
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Why do you think you haven’t been successful in the past in reaching these goals?
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If you were able to reach these goals in the next 3-6 months, how would you feel? How would your life and happiness be different?
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Give me a layout of your current diet + workout routine
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Are you currently tracking your food intake (calories and/or macros)? Have you ever tracked your food intake before?
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Coaching is an investment into your body, your health & yourself - are you ready to make that financial investment?
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Yes! I'm ready to invest into myself
I'm not sure, but I am committed to my goals and willing to explore options to make this investment in myself
No I'm not ready to invest at this time
Submit
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