I'm interested in working with you at Be In Motion Fitness

1

Name

First Name

Last Name

2

Email(I will not use this email for anything other than contacting you directly!)

example@example.com

3

Phone Number(I will NOT give this phone number out or use for anything other than contacting you directly)

Please enter a valid phone number.

4

Time Zone you live in

5

1. Age, 2. Height, 3. Weight, 4. Waist CircumferenceAnd any other measurements you'd like to assess and monitor

7

What are your health, fitness and wellness goals for the next 3-6 months? Why are these goals important to you and why now? Be as specific as possible--again the more information I have the better. If you're interested in nutrition or fitness only coaching, please specify here!

8

Do you have any medical issues or injuries that will affect how you are able to participate in a fitness or nutrition program?

9

What programs have you tried before? Do you have an idea of why you were or were not successful?

10

What are you currently doing to work towards your health and fitness goals? (Current nutrition, Avg steps per day, # meals, cardio, lifting, how many days per week and minutes per day, and how much could you potentially commit to?)

11

Do you have access to a gym?

YESNO

12

Do you have experience lifting? What about with Macro Nutrition?(If no access to a gym, but weights at home, please list what you have available and whether or not you are willing to discuss getting to an an out of home gym.)

13

What made you reach out? Why might working with me be good for you?

14

High Level Full Service Coaching Requires a financial investment. I want us to be able to work together--physically, emotionally and financially. Are you ready to invest in yourself?

Yes, absolutely, I am in.

No

I need this. I will figure out how to make the financial portion work.