The Perfect FIT Coaching Online Application
Fill out this form to get started. Please provide as much information as you can, we will cover what you include in our initial call.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your age range?
35-39
40-44
45-49
50-59
60+
Are you currently experiencing perimenopause or menopause symptoms?
Yes
No
Not sure
Perimenopause/ Menopause
Select the symptoms you are currently experiencing below
Select your current concerns
Sleep issues
Weight gain/body composition changes
Low energy/fatigue
Mood changes
Hot flushes/night sweats
Joint issues
Other
What are your main fitness goals or challenges? (Select all that apply)
*
Weight loss
Increase energy
Stress management
Improve strength
Hormonal balance
Other
Briefly describe your current lifestyle and any challenges you face balancing work, family, and self-care.
What are you hoping to achieve through fitness coaching?
Training and Nutrition Online
What is your current training regime?
Weight training
Cardio/ Walking
Classes
Pilates
CrossFit
Other
How do you describe your training experience?
Beginner
Intermediate
Advanced
How many times per week can you commit to training?
How do you describe your current nutrition habits?
My nutrition habits are letting me down. I don't know where to start
Constantly trying to lose weight, nothing works
Have followed diets with short term success, but they never stick long term
Eat well and have a good understanding of macros. Need some fine tuning
Great nutritional IQ, on top of my eating
Are you interested in adding nutrition coaching to your package?
Yes
No
Medical History and Pre-Screening
Please select any of the following that apply to you
Cardiovascular problems
Joint pain
Respiratory issues
Diabetes
Hypertension
Osteoporosis
Recent surgeries
Chronic pain
Other
Do you have any injuries or physical limitations that I need to be aware of when writing your programs?
Goals, challenges & mindset
What are the 3 top goals you want to achieve in the next 3-6 months?
What are the biggest challenges getting in the way of you achieving these goals?
Have you tried to reach these goals before? If so, what worked well and what didn't?
On a scale of 1-10, how committed are you to making these changes?
Not committed
1
2
3
4
5
6
7
8
9
Fully committed
10
1 is Not committed, 10 is Fully committed
Is there anything else you would like to discuss in our call?
Are you interested in Hybrid Coaching and adding 1:1 personal training to your Online Coaching?
Yes
No
Maybe
Thank you for your inquiry, I will contact you to discuss a time to chat within the next 24 hours.
Submit Inquiry
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