Fit for the FrontLine Application Form
👋 Welcome! I'm so glad you're here. This application helps me learn more about you. your goals, and whether my program is the right fit to support you. Once you submit, I'll personally review it and reach out to book a call it it's a good match. This isn't about being perfect--it's about getting real so I can serve you better. Let's do this 💪
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
How did you hear about us?
*
Please Select
Instagram
LinkedIn
Referred by someone
Other
Please Specify
*
First Responder Role
Firefighter
Police Officer
Paramedic/EMT
Dispatch
Nurse/Healthcare Worker
Other
Department/Station
Years of Service
Current Work Status
Ful Duty
Light Duty
Modified Duty
Off Work
Other
Are you currently dealing with any pain, discomfort, or recurring injuries?
Yes
No
Sometimes
If yes or sometimes, where?
Low back
Mid back
Neck
Shoulders
Hips
Knees
Ankles
Other
How would you rate your pain during activity?
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
On a scale of 1-10, how would you rate your current fitness level? (1 = no activity, 10 = Elite condition)
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
What does your current workout routine look like? (Be specific: how often, what type, structured or random, etc.)
Have you ever had a structured training program before?
Yes, I follow a structured plan consistently
Yes, but I've struggled with consistency
No, I would do random workouts
No, I don't workout regularly
Do you currently have any injuries or pain that impact your job performance?
Lower back pain
Shoulder pain
Knee pain
Hip pain
Neck pain
Chronic fatigue
No current injuries or pain
Other
Which of these tend to increase your symptoms?
Lifting
Bending
Twisting
Sitting for long periods
Standing/walking for long periods
Sudden movements
Repeated effort
Other
If having pain, do your symptoms get worse as the day of shift goes on?
Yes
No
Sometimes
N/A
Have you ever seen a medical provider for any of these injuries? If Yes, what was their recommendation?
Have you ever had surgery or a major injury that required rehab? If yes, please describe.
Do you experience pain or stiffness when performing job-related movements? (E.g.,lifting patients, wearing gear, sprinting, etc.)
Do you feel physically strong enough for the demands of your job?
Yes
No
Sometimes
Do you feel your body holds up through an entire shift?
Yes
No
Sometimes
Do you feel confident handing physically demanding or unpredictable situations at work?
Yes
No
Sometimes
Is there any task at work you currently avoid or feel limited in?
How many hours per week do you work?
Less than 40
40-50
50-60
60+
What type of shifts do you work?
Days
Night
Rotating
How many hours of sleep do you get per night on average?
Less than 4
4-6
6-8
8+
Do you feel more pain, stiffness, or fatigue after your shifts?
Yes
No
Sometimes
Do you feel like your body fully recovers between shifts?
Yes
No
Sometimes
How would you describe your nutrition habits?
Consistently balanced and intentional
I try to eat well, but I struggle with consistency
I eat whatever is convenient, no real structure
Poor nutrition habits, and I know it's a problem
Are you currently working out or training?
Yes
No
Inconsistently
Do you feel your training reflects the physical demands of your job?
Yes
No
Not sure
What do you think is holding you back from improving your fitness or injury prevention? (check all that apply)
Lack of time
Lack of knowledge on what to do
Lack of accountability
Not seeing results in the past
Pain/injuries holding me back
Other
Have you ever invested in a fitness or coaching program before?
Yes, and I had a great experience
Yes, but I didn't stick with it
No, this would be my first time
On a scale of 1-10, how serious are you about improving your performance and reducing injuries? 1 = I just want to dabble, 10 = I'm 100% committed and ready to change)
Worst
1
2
3
4
5
6
7
8
9
Best
10
1 is Worst, 10 is Best
Online coaching with EB Training is a 1:1, high-touch offer with an investment of a few hundred dollars per month. Are you in the financial position to make that investment at this time if this program is the right fit to accomplish your goals?
Yes! I'm all in and ready to start immediately
Yes, I would like to discuss the investment options
No, I am not in the financial position to invest at this time
Are you the main person who makes financial choices for your home?
Yes
No
What are some of the biggest achievements that you have made within this past year?
This is a structured program that requires you to train at least 3X per week. Are you willing to commit to this?
Yes, I can commit to at least 3 sessions per week
No, I'm unsure if I can commit to that right now
This program requires a weekly check-in using a Google Form to track progress. Are you willing to complete this?
Yes, Ill check in every week
No, I likely won't follow through
Are you in a place where you can commit a specific amount of time and energy towards being coached and learning how to get stronger and prevent injury in your work?
Yes, I can commit the time and energy towards being coached
No, I'm unsure if I can commit to that right now
Are you open to feedback and adjustments to improve your movement and performance?
Yes, I want coaching and accountability
No, I prefer to do my own thing
What in particular are you needing from coaching?
What will success in this program look like to you? (Pain-free movement, Increased endurance, Confidence at work)
Why is this the RIGHT time for you to make a change towards your health and strength in injury prevention?
Is there anything else you want to share that will help me understand if this program is a good fit for you?
Is there anyone who is involved in making this decision with you
Yes
No
If yes, how will their life be impacted by you achieving these goals?
Are you ready to show up and do the work it takes to move better, feel better, and perform better?
Yes
No
Please let me know who, if anyone, referred you to my business so I can thank them
Will you be willing to recommend us?
Yes
No
Maybe
Go ahead and schedule your sales call before submitting this form.
If there is something I didn't cover that you would like to share, please include it here.
Submit
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