Coaching Intake Form

1

Full Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Date of Birth* This field is required.

Date

5

How would you describe your current activity level?* This field is required.

Sedentary (little to no physical activity)

Light (occasional walks/light movement)

Moderate (2–3 workouts/week)

Active (4+ workouts/week)

6

What is your current experience level with weight training equipment?* This field is required.

Beginner

Intermediate

Advanced

7

Have you ever worked with a personal trainer or wellness coach?* This field is required.

Yes

No

Sort of/started but didn’t finish

8

Have you ever followed a structured fitness plan?* This field is required.

Yes

No

Sort of/started but didn’t finish

9

What types of exercise do you enjoy? (i.e, Zumba, lifting weights, walking...)* This field is required.

10

What are your top 3 fitness goals right now? List in order of importance.* This field is required.

11

Why are these goals important to you right now?* This field is required.

12

Are you ready to commit to a training plan that includes using a fitness app, physical activity and regular check-ins?* This field is required.

Yes, I’m ready

I’m nervous, but willing

Not sure yet

13

My program involves strengthening body, mind, and spirit. Do you agree with coaching that includes Bible-based encouragement?* This field is required.

Yes

No

Other

14

By submitting this form, you acknowledge that you're ready to invest in your health. You also authorize Coach Fanny B to contact you and determine if we'd be a good match for your goals. Are you ready to get started?* This field is required.

Yes! Let’s do this

I still have questions, but interested