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Client Application Form
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1
Name
*
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First Name
Last Name
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2
Age
*
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Age
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3
Weight & Height
*
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Weight
Height
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4
E-mail
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5
Phone Number
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Area Code
Phone Number
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6
What's your favourite book/movie/podcast?
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7
You're stuck on an island, other than things that will help with your rescue, what 1 item do you bring and why?
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8
How did you find out about online fitness coaching?
*
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9
Have you ever had a fitness coach before?
*
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Yes
No
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10
What is your 3 month fitness goal?
*
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11
In an ideal world, in 3 years what shape would you like to be in?
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12
Why did you choose to apply?
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13
What do you think I can help you achieve?
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14
On a scale of 1 - 10, how committed are you to achieving your fitness goals?
*
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Not Committed
2
3
4
5
6
7
8
9
Super Committed
Not Committed
2
3
4
5
6
7
8
9
Super Committed
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15
How much are you willing to invest in your health and fitness goals?
*
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$100 - $300
$301 - $600
$601 - $1000
$100 - $300
$301 - $600
$601 - $1000
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16
Is there anybody else who may be involved in your decision to hire a coach or stick to a fitness program?
*
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YES
NO
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