Private Coaching Inquiries

1-on-1 Coaching with Mike Dolce

Fill out the form below to have Mike point you in the right direction on your weight loss & fitness journey!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
City, State, Country*
Gender*
Are you married, single, or engaged?*

MarriedSingleEngaged
Current Age?*
How did you hear about us?*
How familiar are you with Mike Dolce and The Dolce Diet?*

Very FamiliarSomewhat FamiliarNot Familiar
Do you own any Dolce Diet books or materials, or have you attended any Dolce Diet related conferences or workshops?*

NoYes (Please List)
If yes, please list below.*
How would you describe your current level of fitness?*

Very fitSomewhat fitNot particularly fitI am not fit at all
What is your current employment status?*

Employed Full-TimeEmployed Part-TimeSelf-EmployedUnemployedStudentStay at home parent
What is your current occupation?*
Height?*
Current Weight?*
What is the lightest you weighed in the last 3 years?*
What is the heaviest you weighed in the last 3 years?*
Goal Weight?*
What has stopped you from achieving your goals in the past?*

Lack of timeLack of knowledgeLack of motivationLack of supportOther
If other, tell me more
Do you have any dietary preferences or restrictions?*

NoneVegetarianGluten-freeDairy-freeOther
If other, tell me more
On a Scale of 1-10 with 1 being "somewhat committed" and 10 being "100% committed," how committed are you to seeing this through until we achieve your goal?*
There will be a financial commitment to work directly with Coach Mike. Are you willing to make a financial investment in achieving this goal?*

Yes, I am ready.No, I am not ready.
To best match you with the best possible plan, what budget are you comfortable committing on a monthly basis?*
Preferred frequency of communication*

DailyWeeklyBi-weeklyMonthly
Preferred style of communication*

Phone callsText messagesVideo callsEmails
Please indicate your typical availability for training sessions: (Example: Mondays and Wednesdays, 1 PM - 2 PM EST)*
What are you most anxious about at the prospect of starting a new fitness program?*
What motivates you the most when participating in a fitness program?*
Why have you decided - today was the day - you will take back control of your life?*
How soon would you be prepared to start?*

TodayTomorrowNext weekNext monthOther
If other, tell me when*
Is there anything else you would like to share about yourself, your goals, or for Mike to know?*
What is your budget for monthly coaching?*

$0-$100$100-$500$500+
NOTE:

Upon submission, Mike will personally read your response and contact you personally via email, text, or phone call.

Phone calls may show up as a "blocked number" on most phone services, so avoid the instinct to block or decline the call and consider picking up!

Congratulations on taking the next step!
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1-on-1 Coaching with Mike Dolce