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1-2-1 Coaching Form
Please fill out and submit this form to apply for 1-2-1 Coaching.
12
Questions
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1
What's your name?
First Name
Last Name
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2
What's your email address?
example@example.com
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3
How old are you?
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4
How many days do you currently exercise per week?
1 Day Per Week
1-3 Days
3-6 Days
Every Day
None
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5
What kind of exercise do you do regularly?
Running
Weights
Calisthenics / Bodyweight
Yoga
Cycling
A Specific Sport (e.g. Tennis, Football, Surfing)
None
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6
What exercise, movement or activity brings you the most joy?
Example - I love to lift heavy weights, swim in the ocean or dance to music
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7
What kind of exercise, movement or activity do you want to do more of in the future?
Example - I want to be able to do a backflip or climb a mountain
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8
Do you have any chronic / persistent body pain at present? If so, where in the body and what is the pain from 1-10?
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9
What is your current level of satisfaction regarding your health & fitness?
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10
How would you rate your average daily energy level from 1-10?
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11
What are you looking to achieve through 1-2-1 coaching?
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12
Are you able to commit to coaching and follow the program for a minimum of 3 months?
YES
NO
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