Personal Training or Wellness Coaching Screening Form
Help us understand your goals and health status to tailor your program.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you interested in a wellness coaching program or personal training?
*
What are your top 3-5 fitness or weight loss goals?
*
How would you describe your current activity level?
*
Sedentary
Lightly Active
Moderately Active
Very Active
Other
Do you have any current or past injuries or medical conditions we should be aware of?
*
What have you tried in the past to reach your goals?
*
What do you think are your top 3 barriers for not achieving your goals yourself?
How motivated are you to start a personal training or weight loss program?
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Not motivated
1
2
3
4
5
6
7
8
9
Extremely motivated
10
1 is Not motivated, 10 is Extremely motivated
What days and times are you generally available for face to face ONLINE personal training sessions?
Is there anything else you would like your trainer to know?
Would you be interested in a 6 week online course that will help you better understand how to make long-term changes stick, reduce guilt and shame with failures and better understand how why we fail and what to do about it?
*
Yes. Sounds like a great entry point to feel things out
No
Maybe. Tell me more
Submit Screening
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