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Coaching Intake Form
Congrats! You're one step closer to losing it all and never feeling uncomfortable in your clothes ever again! Please answer the short questionnaire to qualify for the next step.
12
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1
To confirm, you are filling this out because you want to lose between 10 to 25 pounds of stubborn fat, regain energy, optimize hormones, build lean and toned muscle + make this the LAST COACH you will ever need?
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YES - I am serious, and want to learn more about reaching my dream body, without sacrificing my life.
NO - I am going to leave this page Immediately
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2
What is your name?
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First Name
Last Name
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3
What is your age?
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4
Weight?
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5
Which of the below best describes your goal?
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Choose as many as you like :)
I want to lose between 10 and 25 pounds of stubborn fat, regain the energy I once had, and feel sexy AF in a bathing suit.
I want to restore my hormones, and understand why, my past attempts at “diets” have failed
I want to lose some weight and feel more confident in my skin and regain a healthy relationship with food
I want to ditch tracking macros, and learn to eat intuitively
I’m not exactly sure what my specific goals are, but I do know my approach to nutrition, fitness, and health is not working the way I would like it to
I’m a coach myself, and I understand coaches need coaches. And since I’ve heard lots of good things about you and your program I’m Hoping to learn from your qualified staff, so I can better serve my clients
I have no clue, but I know I need to invest in my health, and personal growth
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6
What is your WHY. What is driving you to make these changes?
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7
What is your current occupation and how long have you been doing it?
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Work environments, have a huge impact on stress, and therefore weight loss. This helps us understand what kind of obstacles we'll be up against.
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8
Do you have a significant other? If so, are they supportive of you potentially investing in your weight loss, health, and personal growth?
*
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Yes, I have a significant other, and they are supportive AF.
Yes, I have a significant other, but this is my decision
Yes, I have a significant other, but they may need to be there with me to make a joint decision
No, I’m single AF, and make my own rules, lol
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9
If you were to find a way to reach your dream body, optimize hormonal function, build an amazing relationship with food, and learn how to keep your results for LIFE, making us the last coach you’ll ever need to hire - would you be willing (and able) to invest in getting the help necessary to get there?
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Yes, I have the cash flow to invest in myself.
Yes, I may or may not have the cash flow, but I’m resourceful and/or have access to credit.
No, my cash flow is month-to-month and I have no access to credit.
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10
What would you expect from me as your coach if we decide to work together? *
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Be specific
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11
What is your email address?
So we can hook you up with some free resources after our strategy session
example@example.com
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12
What is your Phone Number?
Please confirm your mobile number. Its really important that this is correct so we can confirm your application + help you book your free strategy session!
Please enter a valid phone number.
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