Returning 1:1 Client Application

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

What is your Instagram name? Type "N/A" if you aren't on Instagram.* This field is required.

5

When is your birthday? (How old are you?)

6

Can you confirm that you were a previous client?

Yes. I've been one of your clients in the pastNo, I've never been in your program.

7

What are your health/fitness goals?* This field is required.

8

What brings you back? (What's happened since you left? Weigh gain? Weight/muscle loss?)* This field is required.

9

Are you on any special diet currently? (Ex. vegetarian, no dairy, keto, etc.)

10

What do you do for work? What are your typical hours?

11

How tall are you?

12

How much do you weigh now?

13

How many steps do you get (on average) each day?

0 - 3000

3000 - 6000

6000 - 9000

9000+

14

Do you have any medical problems?

YESNO

15

If yes, what conditions(s)? If not, type "N/A".

16

What type of exercise do you get? Describe in detail. (If strength training, what kind/program and how many days per week? If cardio also, what kind and how many days per week?)* This field is required.

17

What are your nutrition frustrations/road blocks as you've tried to do this on your own?

18

Roughly how many times have you been on a diet in the last year?

19

What are your hobbies? What's new with you since we last connected?* This field is required.

20

Is there anything else you'd like me to know?

21

Were you referred by someone? If so, who? If not, type "N/A".* This field is required.

22

Please note that you will be added to my email list (if you aren't still there). You may choose to unsubscribe at any time. You will also receive correspondence from me via email. Make sure to check your spam!

Add me to the list!No, thank you.