My Coach Amanda: Program Prospect Form
Please complete this form to help us understand your current routine, nutrition habits, and goals before starting your personalized program.
Full Name
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First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
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-
Month
-
Day
Year
Date
Gender
Female
Male
Non-binary
Prefer not to say
Other
Current Fasted Weight (lbs or kg)
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Current Height (inches or cm)
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What is your current fitness routine? (Please describe types of exercise, frequency, and duration)
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What are your main fitness and nutrition goals?
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What motivates you to achieve these goals?
Describe your typical daily eating habits (meals, snacks, timing, etc.)
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List the foods you eat most often
Do you have any food dislikes or allergies? Please specify.
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Are you currently taking any supplements? If yes, please list them.
*
Are you currently taking any medications? If yes, please list them.
Do you have any medical conditions or injuries we should know about?
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How would you rate your current stress level?
Very Low
1
2
3
4
5
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7
8
9
Very High
10
1 is Very Low, 10 is Very High
How would you rate your sleep quality?
Very Poor
1
2
3
4
5
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7
8
9
Excellent
10
1 is Very Poor, 10 is Excellent
What is your occupation and typical daily activity level?
Financial Accountability
Please help us understand your financial readiness for coaching.
Are you currently in a financial position to afford coaching services?
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Heck yes! I'm all in and ready to go 👏
I'm ready but I'd like to explore payment options 🙏
I'm not currently financially ready to commit to ongoing coaching 🤷♀️
Coaching Interest
Please select the type of coaching you are interested in.
Which type of coaching are you interested in? (Details are on my website)
*
Basic Plan: Nutrition Plans Only
Premium Plan: Online Fitness and Nutrition
How many days per week are you willing to commit to fitness training?
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I understand My Coach Amanda is a 4 month minimum commitment (minimum of 16 weeks).
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Yes girl and I am ready!!
Not for me, sorry!
What are you seeking to get the most out of having me as a coach?
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Is there anything else you would like us to know before starting your program?
Submit Prospect Form
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