1:1 Fitness and Nutrition Coaching Inquiry
Hi! I'm so happy you are here. I'm Andie, a certified fitness and nutrition coach with a passion for helping you reach sustainable results. As your virtual coach, I am dedicated to being your partner in your wellness journey. Please use this form as a way for me to better get to know you and your goals. At the end of this form, you will schedule a day and time for us to talk more in depth. I can't wait to get started!
Full Name
First Name + preferred name (if applicable)
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Male
Female
Age
Height
Weight
lbs
Goal Weight (optional)
What are your current fitness and nutrition goals? Why are these goals important to you?
What is your experience with exercise?
Please Select
Beginner (I have not exercised in over 6 months)
Intermediate (I have been exercising consistently for at least 6 months)
Advanced (I have been exercising consistently for at 1.5 years)
How many days per week are you willing to commit to exercise?
Please Select
1-2
3-4
5-6
7
What exercise equipment do you have access to?
Gym Machines/Equipment
Dumbbells/Kettlebells/Free Weights
Cable Machines
Resistance Bands
Body Weight
Do you have a gym membership or are you planning to get one?
I currently have a gym membership.
I plan to get a gym membership.
I have plenty of gym equipment at my home.
I would rather not get a gym membership.
Do you know about how many steps you get per day?
On a scale of 1-5, how physically demanding is your job?
Very Sedentary
1
2
3
4
Very Active
5
1 is Very Sedentary, 5 is Very Active
Please list the physical activities that you participate in outside of the gym/work.
What is your experience with tracking macronutrients?
Please Select
I have never tracked macronutrients.
I have tracked macronutrients in the past.
I currently track macrnutients.
Do you know about how many calories you eat in a day?
How many times per week do you get fast food/take-out?
How many alcoholic beverages do you drink per week?
Do you have any dietary restrictions/preferences?
Do you have any medical conditions or injuries that could affect your ability to exercise?
On a scale of 1-5, how would you rate your overall rest/sleep?
Terrible
1
2
3
4
Incredible
5
1 is Terrible, 5 is Incredible
On a scale of 1-5, how would you rate your overall stress?
Very Low
1
2
3
4
Very High
5
1 is Very Low, 5 is Very High
Are you a current cigarette smoker?
Yes
No
Ultimately, this is YOUR journey. These are YOUR goals. As your coach, I will do all that I can to help you reach your goals but this partnership will only work if you do the work. Honesty and adherence to the plan will be the key to your success. On a scale of 1-5, how ready are you to commit to change so that you can reach your goals?
Not ready
1
2
3
4
SO READY
5
1 is Not ready, 5 is SO READY
Please use this space to list any additional information about yourself that you think I should know prior to our call.
How did you hear about me? Feel free to share you IG handle so I can follow you!
Important Note:
Once you submit this form, you will be directed to my calendar to schedule a day and time for our call. If for some reason you are not directed to the calendar, please use this link to schedule: https://calendly.com/agreyfit/30min
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