1:1 Coaching Inquiry

1

What is your first and last name?

2

What is your email address?

example@example.com

3

How old are you?

4

What is your profession?

5

Where are you located?Please list country and if in US, state as well

6

What are your goals working with me?

Train confidently around injury or limitations

Prehab for upcoming surgery

Improve mobility, joint health, movement mechanics

Regain athleticism after injury/surgery having already completed formal physical therapy

Train for longevity- you feel beat up, broken and don't know how to get back on track

Reduce pain or dysfunction

7

Tell me about your movement habits and fitness habits. Is there anything that you are currently unable to do that you enjoy?

8

Do you have any medical conditions? Please list them along with any medications that you take.

9

Please list any past or current injuries that may impact your training.

10

Where do you currently get your fitness programming?

I program for myself

Online coach/training program

In person coach/group classes

I don't currently follow a specific program

11

What if anything could get in the way of you reaching your goals?

12

Although I am a Physical Therapist, I want to make it clear that my online coaching services are not considered medical care or physical therapy. Are you aware that this application is for coaching services and not physical therapy?

Yes, I understand that this is for coaching services and not physical therapy