Welcome to Well Balanced Coaching!
Please take a moment to fill out this application in detail so I can get to know you and your goals more. You will receive a response within 24-48 hours to your email! Make sure to check your junk/spam folder.
Full Name
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First Name
Last Name
Best email to reach you
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example@example.com
How did you hear about Well Balanced Coaching?
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Referal
Instagram
Facebook
Other
What made you interested in Training with us?
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What services are you interested in?
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Nutrition only
Nutrition & Fitness
Training only
Well Balanced Fitness Programs are online only. With the exception for in home PT in Durham region only. This will include a tailored-to-you program, weekly check in support. Is this something you are interested in?
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Online Only
In-Home
Gym Option (Ajax Location)
How do you plan on working out? From home, gym, or both? What type of equipment do you have if working out from home? ex: dumbbells, bands, etc.
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*Only Applicable If Signing up for Nutrition Coaching too* What is your biggest challenge when it comes to your nutrition?
Is there any health information/ concerns we should be aware of? Do you have any current/ previous injuries? Are there any prescribed medications we should be aware of?
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Are there any forms of exercise you need to avoid? Or is there anything you need to focus on?
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Is there any additional health/ medical or personal information you feel we should know to provide you with the best possible service?
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Please describe your current and/ or previous exercise experience
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Please describe your occupation, and would you describe your job as?
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Would you say this occupation was one of the following
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Active
Sedentary
Physically demanding
Other
If you selected "Other" Please elaborate, if not, put N/A
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What are your primary fitness/ health goals? example: weight loss, endurance, strength, flexibility, education, etc.
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What types of training are you interested in?
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High Intensity
Low Intensity
Circuit Training
Heavy Lifting
Yoga/Pilates
Activity Specific
Other
If you selected "Other" Please elaborate, if not put N/A
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What types of exercise do you enjoy? (hiking, spin, dance, etc..)
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Have you ever worked with a Coach/Trainer before? What was your experience? What did you like/dislike?
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On a scale of 1-10, how confident do you feel about committing to coaching?
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If you decide to move forward with 1:1 Coaching (we will discuss all the options for packages/investment) We do want to make sure you've considered this investment in your health?
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I have and I'm READY!
Yes, but I'm nervous
No, I'm not ready to invest in my health
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