Full Name
*
First Name
Last Name
Gender
*
Male
Female
Age (you have to be 25+ for TransformHER coaching)
*
years
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
How were you made aware of my services?
*
Facebook
Instagram
Pure Gym Website
Classes in the gym
Referred by a friend/family
Email
Other
If referred by someone, please write their name below:
Getting to know you!
Just a few questions so that I can get to know a little more about you.
Occupation & usual working hours
*
What made you reach out for coaching right now?
*
How would you describe your lifestyle right now?
*
What does feeling your best self look like to you?
*
Your current lifestyle & wellbeing
Answer in as much detail, so I get a good idea of where you're currently at.
On a scale of 1–5, how would you rate your current work/life balance?
Worst
1
2
3
4
Best
5
1 is Worst, 5 is Best
What’s your current sleep routine like?
How do you usually manage stress or feeling overwhelmed?
What do you do just for YOU — hobbies, downtime, self-care?
Fitness & Movement
How do you feel about exercise right now? (love it, dread it, inconsistent?)
What kind of movement do you enjoy most? (Gym, Walking, Gym Classes, Pilates, Yoga etc)
Do you have any injuries/limitations I should be aware of?
Nutrition
How would you describe your relationship with food?
Do you find you have steady energy throughout the day, or highs & crashes? (select all that apply)
*
Steady energy
Highs & crashes
Always feel exhausted
Are there any diets that you’ve tried before that did/didn’t work for you?
Mindset & Confidence
How do you currently feel about yourself — your confidence, self-talk, body image?
What limiting beliefs or fears do you feel are holding you back right now?
What would you LOVE to say about yourself in 6 months that you can’t say right now?
Support & Accountability
What kind of support helps you most?
gentle encouragement
tough love
accountability check-ins
a mixture of everything
Have you ever worked with a coach before?
No
Yes
Other
What did you like/dislike about the experience?
Your Vision
In 3 months’ time, what would make you say: “I’m so glad I did this”?
Please select a date/time below, so that we can discuss your goals in further detail & also discuss the coaching options that would suit you best.
Submit
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