New Customer Registration Form

Coaching Application Form

Fill out the form to apply for coaching opportunities

Client Details
Client Name:
Full Name*

First NameLast Name
E-mail*
example@example.com
Instagram Handle
@something_something
Phone Number*
Please enter a valid phone number.
Best way to contact you:*
please put your preferred method for me to reply to you.
City AND Country where you live:*
Age:*
e.g., 23
Weight (lbs)*
e.g., 200lbs
Height (inches)*
e.g., 72 in
Gender
What do you do for work?*
Profession
What Type of Coaching are you Applying for?*

Lifestyle CoachingShow PrepCustom Exercise Program onlyNutritional Coaching only

Personal Goals
How Active are you DAILY?*

SedentaryLow ActivityModerately ActiveVery ActiveEXTREMELY ACTIVE
How many steps do you achieve daily?*
How many days a week are your strength training?*
What is your average hrs of sleep?*
Have you worked with a coach before?*

YesNo
Primary Goals - What do you want to achieve with me? What are you goals?*
Please be as specific and detailed as possible, especially regarding long term goals.
Why is this goal important to you?*
Please be as specific as possible.
Are you willing to invest money in this goal?*
What does your current training routine look like?*
Please be as specific as possible.
Injuries, Health Concerns/Conditions or Mobility Issues*
Any (and all) physical limitations, imbalances, asymmetries, injuries, etc...
Why are you interested in working with me?*
Please be as specific as possible.

Nutrition
Current Daily Macros / Calories *
It is okay if this is "ball-parked" or if you don't know or have never tracked this. Please just specify.
Any/All Important Nutritional Information*
Allergies, Digestive Issues, Dietary Preferences or Limitations (such as money or time restrictions)
Current Supplementations or Medications
Vitamins, Minerals, Supplements or Medications
How often do you drink alcohol?*
There is zero judgment - please be truthful.
Do you smoke and/or vape?*

YesNo
Any other important information you would like to share:
Anything that concerns you - concerns me.
Do you plan to compete in Bodybuilding (CPA, IFBB, NPC, WNBF)?*

Yes, this seasonYes, at some pointUnsure, not opposed to the ideaNo, not my thing
Current Physique - Attach photos

To provide further insights to your current physique
Cancelof
Should be Empty:

Coaching Application Form