Online Coaching Application Form
To Accomplish Your Goals Lets Go!
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Age
Country
Gender
Female
Male
Prefer not to answer
Other
What is your PROFESSION?
Do you have any medical conditions or injuries?
Yes
No
Please give details
Current weight
Current height
How many days per week do you plan to exercise?
Please Select
1 Day
2 Days
3 Days
4 Days
5 Days
6 Days
Everyday
How many hours per day do you plan to exercise?
Please Select
1 Hour
1-2 Hour
2-4 Hour
4-6 Hour
More than 6 hour
Please list the goals according to your priority. (First 3 option will be prioritized.)
Which best describes YOU right now?
I don't know where to start
I have started but have reached a plateau
I need accountability and guidance
I know what to do, but it's taking too long by myself
Other
What has stopped you from achieving your goals so far?
Lack of knowledge
Lack of Time
Lack of commitment
Lack of accountability
How motivated are you to change your life by investing your time, money and hard work?
Not much
1
2
3
4
5
6
7
8
9
Very
10
1 is Not much, 10 is Very
How long would you like to work with me?
3 Months
6 Months
12 Months
24 Months
In detail, is there anything about you that you think would give me a better understanding of your journey so far, & where you want to go?
What's ONE thing that would have to happen for you to be satisfied with the results of this program(weight, mindset, habits, relationship's)?
START!
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