Start With Sarah Intake Form
Please Fill Out This Form. As it will help me get to know you better so our first session can go smoothly.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your primary goal for applying to work with me? (e.g., improve strength, get out of pain, stay consistent with workouts, etc.)
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Have you had a coach before?
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Yes
No
If you answered yes to the above question, what worked? What didn’t work?
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How often do you currently exercise, and what types of exercise do you do? (no worries if you aren’t doing any exercise)
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if you clicked other, write the other symptoms you are struggling with
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Do you have any muscle or joint pain? If yes please list where?
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If you said yes on the question above, how would you describe your pain?
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sharp
dull
achy
pins & needles
Other
What medications are you on and for what reason?
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What does success look like to you? What do you want to be able to achieve in the next 3-6 months?
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On a scale of 0-10 right now, how confident are you that you can achieve the above stated successes?
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Please Select
0 ( no confidence)
1
2
3
4
5
6
7
8
9
10 ( very confident)
What would help raise your confidence by 2–3 levels from where it is now?
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Submit
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