Berger Coaching Intake Form
Elevate your life, health & energy levels
1. Personal Information
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
Date
Email
example@example.com
Phone Number
-
Area Code
Phone Number
2. Current Situation
How would you describe your energy levels and physical condition?
A. Very energetic and in excellent physical shape
B. Generally energetic and in good physical condition
C. Sometimes energetic with average physical condition
D. Often tired and in poor physical condition
What are the biggest challenges you're currently facing?
How would people in your social circle describe you?
3. Goals & Commitment
What are the most important goals you want to achieve through the coaching?
Increased energy
Higher earnings
Becoming happier & healthier
Becoming more masculine & attractive to women
Other
How do you believe this program will benefit you in the short and long term?
How much are you willing to invest in yourself to elevate your life?
250-500 EUR
500-1000 EUR
1000+ EUR
Submit
Should be Empty: