Apply for 1:1 Coaching with Kristin

Apply for 1:1 Coaching with Kristin
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
What do you do for work? Is it physical or sedentary?*
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
Age*
Height (in CM)*
Weight (in KG)*
Instagram handle*
What goals are you hoping to reach with my support?*
E.g. gut/hormone health, build muscle/or drop body fat, comp prep...
What is your current diet like? - Please be specific - what foods are you currently eating, how many meals per day etc*
What are your current calories? *
Do you have any food intolerances/allergies?*
Do you have any medical conditions? Please be specific - e.g. Diabetes, Crohns, PCOS, Autoimmune etc*
If you are on any medications, please list them.
Please list the foods that you dislike*
What is your sleep like? How many hours per night?*
Do you have children? If so, how many?*
How is your libido like?*

LowAverageHigh
What supplements/vitamins do you currently take?*
How are your stress levels?*

LowModerateChronic
Are you on any drug enhancements/ or have you taken any before? *
What do you do for exercise? (Please include how many days per week)*
This can include: Weight training, walking, yoga, etc
What time of the day do you train?*
Do you have any injuries or limitations?*
Gut health: Do you suffer from any of the following?*

Reflux/heartburnBloating/abdominal discomfortConstipationDiarrheaIBD (Crohn’s Disease, UC)IBSCeliac DiseaseSIBONauseaCandida overgrowthDiverticulitisNone of theseOther
Lifestyle + Mental: Do you regularly experience any of the following?*

Stress/AnxietyLow self-confidenceNegative self-talkLimiting thoughts/beliefsSelf-sabotagingDepressionPoor relationship with foodNone of theseOther
Do you wake up frequently through the night to pee? *
Do you experience hot flushes or night sweats?*
Do you feel dizzy when exercising?*
Do you experience energy crashes throughout the days? If so, what time of the day roughly?*
FEMALE ONLY: Do you get a regular cycle?
Does it arrive on time? Do you experience heavy or bleeding.. etc
FEMALE ONLY - When is your cycle due?
FEMALE ONLY: Are you on birth control?
FEMALE ONLY: Do you experience sore breasts or aches around your cycle?
FEMALE ONLY: Do you experience stomach pains during ovulation (the lead up) and during your period?*
Do you experience pain on one side of the stomach? If so, which side?
Anything else you would like me to know about your health/lifestyle?*
Are you ready to commit to a minimum 12-week+ coaching program, with investment options ranging between $1,400–$1,800 AUD?*

Yes, I’m ready to commit!Not at this time
When are you looking to take action on your health goals?*

As soon as possible!Sometime in the near future. I'm not quite ready yet.
How would you like to be contacted?*

EmailInstagram
Please allow 24hours for a response. If you are wanting an email response, please keep an eye out in your spam/junk mail aswell.
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Apply for 1:1 Coaching with Kristin

Please allow 24hours for a response. If you are wanting an email response, please keep an eye out in your spam/junk mail aswell.