Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Which service are you booking today?
Live Golf Coaching – $50/hr
Remote Golf Coaching – $40/hr
Live Personal Training – $40/hr
Remote Personal Training – $40/hr
Nutrition Counseling – $20/hr
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What is your main goal for this coaching?
*
Examples: improve ball striking, lose 10–15 lbs, move pain-free, build strength, etc.
Have you worked with a coach or trainer before?
Yes
No
If yes, what worked well and what didn’t?
How would you describe your current fitness / performance level?
*
Beginner
Intermediate
Advanced
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Do you have any old injuries or surgeries?
*
No
Yes (briefly describe)
Please list injury/surgery, when it happened, and current status.
Do you currently have any pain or limitations?
*
No
Yes (describe)
Describe your current pain or limitations.
Any medical conditions I should know about before we train?
*
Heart issues, blood pressure, asthma, medications, etc.
Have you been cleared for exercise by a doctor?
*
Yes
No
Not Sure
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What does a typical week look like for you? (work, family, training)
*
How many days per week can you realistically train?
*
2 days
3 days
4 days
5 days
6+ days
Preferred training time (local time)
*
Early morning
Late morning
Afternoon
Evening
Do you currently have access to a gym?
*
Yes
No
What training equipment do you have access to?
*
Barbells
Dumbbells
Kettlebells
Machines
Bands
TRX / suspension trainer
Cardio machines (bike, treadmill, rower)
Only bodyweight / minimal equipment
Home gym (describe)
If you selected "Home gym", briefly describe your setup.
For golf athletes: what golf equipment do you regularly use?
Full set of clubs
Range / practice facility
Course access
Indoor net / bay
Launch monitor
Putting mat
None of the above
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Optional: upload any videos or photos you’d like me to review
Browse Files
Drag and drop files here
Choose a file
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Anything else you want me to know before we start?
Agreement & Consent
*
I confirm that the information I’ve provided is accurate.
I understand this is coaching and education, not medical diagnosis or treatment.
I agree to Defy LLC’s terms and conditions.
Type your full name as your digital signature
*
Date
*
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Month
-
Day
Year
Date
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