12 Week Group - WEST COAST WELLNESS

Name

First NameLast Name

Height

Current Weight

Phone Number

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Age

Gender

Email

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If Coaching goes exactly the way you would like, what would you need to accomplish, work on, and improve on? Our goal is for you to be able to say at the end "coaching was more than successful."

Please list physical fitness goals, lose weight, change body composition, increase muscle mass, lower body fat%, etc. Please explain in detail

Do you have any health conditions that may have an affect on your health, wellness, fitness goals?

If yes, then please share them below:

Ideally, in the next 90 days what emotional/mental improvements would you like to see? WHAT WOULD NEED TO HAPPEN MENTALLY/EMOTIONALLY FOR YOU TO SAY COACHING WAS A SUCCESS?

How is your sleep? Do you sleep through the night? What time do you go to bed? Do you have a night routine or does bedtime and wakes-ups shift? On average how many hours of sleep do you get a night?

In the past, what has been the biggest struggle with making progress and/or hitting goals?

What are you willing to do to achieve your goals?

What gym equipment do you have access to? Will you be working out from home or the gym? If at home, what weights (Barbell, Dumbbells, etc). What weight do they go up to (10, 15, 25, 30, 40, 50 etc)

As your coach my one of my goals is to keep you committed to your desired goals and moving forward in them! We all have hard spots, moments etc. What would you like me to say to you, how would you like me to encourage you when you feel like giving up? Exact verbiage helps because we all need a different style of communication when we are in a low point.

AGREEMENT:

West Coast Wellness Group Coaching Agreement
This Agreement outlines the expectations and commitments between West Coast Wellness
(“Coach”) and the Client (“You”) as part of the Group Coaching Program. By signing this Agreement, you acknowledge and commit to the following:

1. Commitment to the Program
- You are enrolling in a minimum 3-month commitment to the West Coast Wellness Group Coaching Program.
- You understand that success requires showing up fully, engaging in scheduled calls,
completing program activities, and implementing the strategies provided. I commit to the entire 12 weeks. There are no refunds. Once the 12 Weeks are over you may move into any other program you desire.

2. Confidentiality
- All 1:1 conversations between Coach and Client are strictly confidential.
- “What I see here, what I hear here, stays here.”
- The data gathered from intake forms or check-ins will only be used to tailor coaching to your needs and goals.

3. Client Responsibilities
- Coachable: You will remain open-minded, receptive to feedback, and willing to try new approaches.
- Committed: You are dedicated to giving this program and yourself the best effort over the next 12 weeks.
- Ready to Change: You understand that in order to be successful, it is vital to follow the plan agreed upon with your coach.

4. Coach Responsibilities
- Providing structure, accountability, and expert guidance.
- Offering tools, resources, and strategies designed to support your progress.
- Holding you accountable in alignment with your stated goals.

5. Acknowledgment
By signing below, you affirm your commitment to fully participating in this program,to
respecting confidentiality, and to embracing the process of change for your health and
wellness.

Sign Here:

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WCW