Personal Coaching/Online Coaching Sign Up

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Name* This field is required.
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Phone number* This field is required.
Please enter a valid phone number
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Email* This field is required.
example@example.com
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Date Of Birth* This field is required.
Date
Day
Month
Year
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Type of Coaching* This field is required.
1-1 in Person SessionsOnline Coaching
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What are your short and long term goals?* This field is required.
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What Is Your Current Weight and Height?* This field is required.
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What do you think your top challenges will be?* This field is required.
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Check any boxes that applies to you:* This field is required.
Have you had any surgery in the past year that may affect your physical activity?
Do you have a heart condition, high blood pressure or circulatory problems?
Do you experience pain in your chest when exercising or at rest?
Do you have asthma?
Are you taking any medication?
Do you suffer from epilepsy?
Do you have diabetes?
Do you have back pain?
None
Other
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If any boxes are checked please provide details.
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How Would You Rate Your Current Nutrition?* This field is required.
1 - Terrible All The Time
2 - I Try, But Eat Rubbish Most Of The Time
3 - Ok, Do My Best But Binge At The Weekend
4 - Mostly Good, But Could Do With Some Support
5 - Excellent, I Understand Exactly What I Should Be Eatin
Other
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If you can give me some background info about your eating habis, experiences with weight loss, weight gain, what you've tried, what worked, what didnt, etc.* This field is required.
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Are you or have you ever tracked calories and/or macros?* This field is required.
YESNO
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If you currently are, how many calories are you consuming?
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How often do you weigh yourself?* This field is required.
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Have you been losing, gaining or maintaining your weight recently?* This field is required.
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When It Comes Down To The Gym, Exercise & Movement, What Do You Enjoy?* This field is required.
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And What Do You Dislike?* This field is required.
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Which Of These Describes Your Current Activity Levels?* This field is required.
Sedentary - Desk Job, No Exercise, Very Few Steps A Day
Lightly Active - Exercise 1-3 Times Per Week, Some Walks
Moderately Active - Exercise 3-5 Times Per Week, Regular Walks
Very Active - Exercise 6+ Times Per Week, Daily Walks
Other
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What is your current training split? (e.g. PPL, upper/lower, full body, etc)* This field is required.
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What is your availability like throughout the week to get a workout in?* This field is required.
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What do you do for work? I ask to get an idea how active you are, and how your work may impact your schedule and nutrition. Uncommon work hours and a lot of traveling are two examples of things that can add an extra challenge to staying on top of health and fitness goals.* This field is required.
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Would you like to add anything else that you think will benefit my understanding of you and what you want to achieve?
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How many sessions would you like per week* This field is required.
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Are You Ready To 100% Commit To Making A Positive Change To Your Health & Lifestyle?* This field is required.
YES!
No, I'm Not Ready Just Yet
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