1-ON-1 ONLINE COACHING
Welcome to 1:1 Coaching w/Ashley Kailing
Name
First Name
Last Name
Birth Date
Please select a month
January
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Month
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Day
Please select a year
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Year
Gender
Female
Male
Height
cm
Weight
kg
Email
example@example.com
Do you have any diagnosed health problems?
Are you taking any medications? If yes, please list below.
Do you have any injuries? or past surgeries? If yes, please list below.
How does your current diet look like?
Low-fat
Low-carb
High-protein
Vegetarian/Vegan
No special diet
Intermittent Fasting
Other
Do you smoke?
Yes
No
What is your daily activity level?
None
1
2
3
4
High
5
1 is None, 5 is High
What is your daily stress level?
Low
1
2
3
4
High
5
1 is Low, 5 is High
How often do you currently train per week?
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Please rate your readiness to change.
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
What is your main overall goal and the reason that made you reach out to me today?
Submit
Should be Empty: