Wellness Coaching Application

1

Name

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

4

Which one best describes you?

I have never worked out before. I want to learn how to strength train and create a gym routine. My main goal is learn how to make exercise a regular part of my lifestyle.

I'm not new to the gym but need more guidance on what to do. I want to learn how to train for my goals. It's easy for me to stay motivated if I know what I'm doing.

Having someone hold me accountable and having plans created for my goals is most important to me. I have a lot of experience working out but need support to make sure I stay committed. I go through phases of being unmotivated.

Nutrition is my biggest barrier. I'm not sure what or how to eat for my goals and overall health.

5

What do you believe is currently holding you back from reaching your goals?(busy work life, finances, kids/family, limiting beliefs, low energy, etc)

6

How do you typically respond to stress, setbacks, or discomfort?

7

Are you willing to commit to at least 3 months of a plan focused on consistency and sustainable habits?

YESNO

8

How soon can you get started?

Today

This week

Next week

Next month

9

Where do you see yourself in the next 6 months?Select multiple (if applicable)

Lost at least 5-10 pounds

Gained at least 5-10 pounds/more muscle definition

Consistently working out every week

More confident & higher self esteem

Healthier eating habits

Break free from limiting beliefs or negative self talk

Established routines (morning and/or night)

Better sleep and work-life balance

10

Is there anything else you want to share with me as your wellness coach?

11

How did you hear about us?

Instagram

TikTok

Referral (someone you know)

Other