EXECUTIVE PERFORMANCE & LONGEVITY COACHING Client Application
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
City and State
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How would you describe your current training routine?
*
Consistent structured training
Inconsistent / off and on
Used to train but not currently
Just getting started again
How would you rate your current energy levels? (1–10 scale)
Do you currently experience pain, injuries, or movement limitations that affect training?
What has been your biggest obstacle to training consistently?
Time constraints
Work stress
Lack of structure
Injuries or pain
Motivation
Travel schedule
Other
What are your top 3 physical goals right now?(Example: strength, energy, body composition, longevity, confidence, performance, injury prevention)
Why are these goals important to you at this stage of life and career?(Long response — this reveals emotional buying drivers.)
If nothing changes over the next 2–3 years, what concerns you most about your health or performance?
On a scale of 1–10, how committed are you to improving your health and performance right now?
How many days per week can you realistically dedicate to training?
2
3
4
5+
Are you willing to follow a structured training and accountability system?
Yes
Not Sure
No
Have you worked with a coach or trainer before?If yes, what worked well and what didn’t?
What are you looking for in a coaching relationship that you haven’t found elsewhere?
This is a premium coaching program designed for professionals committed to long-term results. Investment begins at $650/month. Are you prepared to invest at this level if the program feels like the right fit?
Yes
Possibly (Need more information)
No
Why do you feel now is the right time for coaching?
Is there anything else you’d like me to know before our strategy call?
Submit Application
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