Online Coaching Application

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Instagram Handle:

What are some specifics of your goal, or areas that you'd like to improve upon or receive help with?

What motivates you towards your goal the most?

In the past 6 months, what steps have you taken toward your goal?

What's something that has prevented you from getting to your goal? Either currently, or in the past.

What is your current profession? (What does your daily life/schedule look like? i.e. work from home, office, field work, ect. )

What is your experience level with strength/weight training?

BeginnerIntermediateAdvanced

Tell me about your current activity level (average step count, if known), how many times per week you exercise, and add current training split (if applicable).

What would you rate your current nutrition 1-10? (1= Poor, needs improvement/ 10= Optimal.)

What would you rate your current energy levels on a day-to-day basis? (1= Tired/lethargic. 10=Full of energy all day.)

What would you rate your stress levels on a day-to-day basis? (1=Not stressed at all/ 10= Stress consumes my life.)

How supported do you currently feel from the people around you to hitting your goal? (1= Not very supported/ 10= Extremely supported, I have told people closest to me about my goals and they are encouraging and understanding of what I'd like to accomplish.)

How is your sleep? (Choose multiple if applicable.)

I get adequate amount of sleep (8+ hours) and wake up well rested and energetic.I wake up groggy and often feel tired throughout the day/ feel the need to take naps.I have trouble falling asleep.I have trouble staying asleep.I just don't get adequate amount of sleep.

Have you worked with a coach before? If yes, how was your experience/what did you like/dislike?

Which services are you interested in? (May Select Multiple)

Online Nutrition CoachingOnline Training CoachingIn-Person Coaching (DFW Area)

Please include anything else below that I should be aware of (injuries, chronic illnesses, medications, conditions, ect.)

How did you hear about me? Did anyone specific refer you?

When is the best time to contact you?

Morning (8AM-12PM)Afternoon (12PM-4PM)Evening (4PM-8PM)

What time-zone are you in?

Thank you for reaching out! I will be contacting you within 24-48 business hours to schedule a call to further discuss working together or if you have a preferred date of contact, please include below!

Date

Not required, but please add current photos if you have them.