Welcome

1

Welcome To Moving Forward Fitness

I’m so glad you’re here. 💛

This form isn’t about being perfect. It’s about being honest. Vulnerable. Real.

It’s the first step in showing up for yourself in a new way — one that doesn’t involve hating your body, punishing yourself with food, or starting over every Monday.

I’m not here to “fix” you. You’re not broken.

But if you’re tired of feeling stuck… if you’re craving more confidence, more energy, more strength — and a healthier relationship with your body and food — then you’re in the right place.

Take your time. Be open. I’ll be reading every word with so much love and care.

This next chapter gets to be different — and I can’t wait to walk through it with you. 💫

Let’s do this together. 🖤

xx,

Miranda
2
What’s your first & last name?* This field is required.
First Name
Last Name
3
What’s your Age?* This field is required.
4
What is the best email to reach you?* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
5
What is your IG Username?* This field is required.
6
Tell me a little bit about yourself!? ❤️* This field is required.
Huge
Large
Normal
Small
Ok
Ok
7
What made you hit “apply” today?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
8
Current weight (approximate)* This field is required.
9
Goal weight (if you have one)* This field is required.
10
What are your current health/fitness goals?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
11
What’s feeling really hard right now when it comes to your body, food, or fitness?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
12
Are you currently working out? If yes, what does that look like?* This field is required.
13
Do you have access to a gym or home workout equipment?* This field is required.
14
What does a typical weekday look like for you? (Work, kids, meals, etc.)* This field is required.
Huge
Large
Normal
Small
Ok
Ok
15
How many days per week are you realistically willing to dedicate to fitness?* This field is required.
16
Do you live alone or with others? Does your environment support your goals?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
17
Are there any medical conditions, injuries, or hormonal concerns I should know about?* This field is required.(Includes PCOS, thyroid, joint pain, etc.)
18
Are you a smoker?* This field is required.
YESNO
19
How long have you struggled with exercise, weight, or consistency?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
20
How would you describe your current relationship with food?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
21
Have you had any experiences with disordered eating, diet culture, or over-exercising in the past?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
22
What has or hasn’t worked for you in the past (diets, workout plans, coaching, etc.)?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
23
What tends to throw you off track the most? (stress, social events, time, motivation, etc.)* This field is required.
Huge
Large
Normal
Small
Ok
Ok
24
Tell me your WHY. Why do you want to make a lifestyle change right now?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
25
What would success look and feel like for you 3 months from now?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
26
What’s your number one goal in hiring me as your coach?* This field is required.
27
On a scale of 1-5, how committed are you to showing up for yourself (even on the hard days)?* This field is required.
1
2
3
4
5
Sort of Ready
I’M READY! Let’s go!💪🏻
28
What kind of accountability works best for you?* This field is required.
Tough Love
Reassurance
Gentle Reminders
Information & Learning
29
Are you ready to be open and honest with me through the ups and downs of this journey?* This field is required.Communication & transparency help me help you to the best of my ability! ❤️
30
When would you ideally like to start?* This field is required.
Date
Year
Month
Day
31
Coaching with me is a real investment — emotionally, physically, and financially. Are you in a place to commit to that right now?* This field is required.
32
What type of coaching/training are you seeking?* This field is required.Please note, In Person Personal Training is based out of DeMelo Fitness located in London, ON.
1:1 Online Coaching
In Person Personal Training
Both, I want the full Accountability & Support Package!
Nutrition Only, with Weekly Check-Ins
33
Last Question! Were you referred to me by someone? If Yes, who?* This field is required.I have a referral program, so I want to make sure they get recognized for sending you my way!
Should be Empty: