1:1 Coaching with Simone Jacks

Hey Girl,

Thank you for showing your interest in being coached by me! This form is for any ladies wishing to be coached online or face to face by me!

I am looking for ladies who want to commit to change and are willing to learn new methods and skills.

I coach women who have never lifted a weight in their life or have been training for years and want to upskill and work on their form.

I am skilled in training women who:

Have had breast augmentation/reduction/explant surgery and the pain or limitations this may place on you
Have endometriosis or PCOS
Have anxiety and struggle with consistency

I have personally experienced all of these issues and figured out ways to be able to live a healthy lifestyle in spite of these setbacks.

My goal with my clients is to teach them how to achieve their goals.

I understand that more often than not, your own mental barriers get in the way of you achieving your goals. I know it is not as easy as being told how to train and what to eat, you need that mental support too, and that’s what I am here for!

My methods for training will involve activation exercises to remove pain from your life and training long term and achievable/intelligent training programs to suit your needs/wants.

I will not only show you what to do with your nutrition but I will guide you and educate you, so you have the power to make your own nutrition decisions autonomously

WHATS INCLUDED WITH ONLINE COACHING:

Custom training programming
Weekly 1:1 check ins
Custom nutriiton
Feedback on technique
Voxer Mindset support
Weekly/Bi-Weekly/Monthly 1:1 call offering

8-week minimum lock-in
I also offer 1:1 and 2:1 Personal Training out of Remedy Grounds in South Melbourne or outdoor sessions around St Kilda/Albert Park/Middle Park/Port Melbourne/Prahran locations.
In special cases in-home training can also be organised, this may incur a higher due to travel/distance.

Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Area CodePhone Number

Mailing Address*

If you join you will be sent a Welcome Pack

What is your IG handle?

Where did you find me?

InstagramTiktokWord of MouthOther

If you were recommended by a friend, who?

What sort of coaching/mentoring are you interested in?

Fitness Programming/Form Reviews/AccountabilityNutrition and Meal PlansMindset and accountability

Date of Birth

Height

Current Weight

If you are wanting to lose weight please add your ideal weight

Last time you were at ideal weight?

What is your MAIN goal right now?

Drop body fatGain muscleMaintain where I am atI just need some accountability and support!

What would you consider your current training level?

Full Beginner! Never done weightsBeginner - IntermediateIntermediate - AdvanceAdvanced

If you have been training consistently do you follow a training program?

YesNo

Have you ever had an online coach or face to face coach?

Do you have any injuries or ailments that can effect you training specific parts of the body?

Do you have any female reproductive issues ? (ie. PCOS, endometriosis etc)

Do you have breast implants or have you had any breast surgeries?

Tell me a bit about you and your fitness journey. What are your struggles?

What do you think the main thing is that is holding you back from achieving your goals, or has held you back in the past?

What made you make the decision to reach out to me in particular as a coach?

Have you followed a meal plan before?*

YesNo

Do you have any food preferance / intolerane / allergy?

Are there any foods you really enjoy or dislike?

Are there any foods you just can not live without and would like to see if they will fit in your meal plan? *this is not a guarantee

I am committed to getting you the results you want! We will have an initial start up call before we get started so I can run through your goals, get to know you and begin to write a plan that is going to be best suited to you. All of my coaching is completely customised, no cookie cutter plans here!

A gentle reminder that any coaching does that a level of commitment from you!

Do you experience anxiety or depression?

AnxietyDepressionBothNone

Please elaborate on the above or if you have any mental health concerns I should be aware of that may impact your ability to stay consistent.

Are you interested in:

Training Program (Programming and Check-Ins)Nutrition Only (Custom Weekly Meal Plan & Check-In)Training Program & Nutrition (Weekly Check-In)Training Program, Nutrition & Accountability

How many weeks would you like to commit to?

Are you willing to invest $120-200 per week towards a new you? (Online only price range, F2F training prices will vary depending on how many sessions per week and if they are at in your home or in the gym I work out of in South Melbourne)

YES! I'm ready to take actionNot ready just yet

Lastly, are you interested in online or face to face?

OnlineFace to faceBoth (minimum 1 session per week face to face plus following your program)

1:1 COACHING WITH SIMONE

Fitness

Nutrition/Meal Plans

Mental Health

Final questions