Online Coaching Application - Willow Wellness Co.

STRENGTH-NUTRITION-MINDSET

Strong body. Aligned mind. Your breakthrough starts here.
BASIC INFO
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Birth Date

MonthDayYear
Postal code search

READINESS & INTENT
Why are you currently interested in online coaching?

How committed are you to making changes over the next 3-6 months?

	1	2	3	4	5

1 is Worst, 5 is Best

Have you worked with a coach before?
If so, what do you feel worked and what didn't?

FITNESS BACKGROUND
Height
Current Weight (optional)
Are you comfortable tracking progress (photos, weight, measurements)?
How long have you been training consistently?
Where do you train?
What equipment do you have access to?
How many days per week are you able to realistically train?
What workouts do you enjoy?
Are there any movements or workouts you dislike or avoid? Explain:

MINDSET (NON-CLINICAL)
This coaching includes mindset and habit support and is NOT therapy or medical treatment.
How would you describe your relationship with your body?
How often does stress affect your eating or workouts?
Do you struggle more with motivation or consistency? Why?
What negative thoughts come up around food, fitness, or your body?
What mental or emotional habits do you want to improve?

LIFESTYLE & RECOVERY
What is your work schedule?
How many hours do you typically sleep per night?

Current Stress Level

	1	2	3	4	5

1 is Worst, 5 is Best

What are your biggest obstacles with consistency?
Any upcoming travel or life changes?

HEALTH & SAFETY
Do you have any injuries or physical limitations?
If so, please explain:
Do you have any medical conditions that may affect training or nutrition?
If so, please explain:
Are you cleared for exercise by a medical professional?
Are you pregnant or postpartum?

GOALS & VISION
What are your top 3 goals with coaching?
What would success look like in 3 months to you?
What would success look like in 6-12 months to you?
Why are these goals important to you?

COACHING EXPECTATIONS
What support do you need most?
How do you prefer feedback and communication?
Are you open to being coached honestly and challenged?

COMMITMENT CHECK
Should we both feel aligned, are you prepared to financially move forward with coaching?
Online coaching requires consistency and effort - do you understand this?

YOUR SPOTLIGHT
Is there anything else I should know about you?
Do you have any questions for me?

CONSENT/AGREEMENT CHECKBOX (REQUIRED)
By submitting this application, I understand that:

1. This coaching program provides guidance on fitness, nutrition, and mindset/habits, and is NOT a substitute for medical advice, diagnosis, or treatment.

2. I am responsible for my own health and safety and will consult a qualified healthcare professional before making significant changes to my diet, exercise, or lifestyle if needed.

3. l agree to participate honestly, follow the coaching program to the best of my ability, and communicate openly with my coach.

4. I consent to the use of my submitted information (including measurements, progress photos, and questionnaire responses) solely for the purposes of personalized coaching.

5. I understand that results require consistency, effort, and patience, and that the coach can NOT guarantee specific outcomes.
Signature
Should be Empty: