Ladies and gentleman it's time to create our game plan!
Basic information and primary goal
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Birthday
*
/
Month
/
Day
Year
Rank your current level in the following categories:
Nutrition
1
2
3
4
5
Motivation
1
2
3
4
5
Stress
1
2
3
4
5
Physical Activity
1
2
3
4
5
What do you do for work and are you mainly sitting, standing, or active throughout your day?
*
Describe any repetitive motions you do throughout the day.
What is your highest priority goal you would like to accomplish and what result would you like to achieve by working with me?
*
The more specific the better!
Why are these your goals?
*
Knowing your why is vital to your success.
Describe your number one struggle with reaching this goal.
*
Your biggest roadblock preventing this goal from happening.
Describe how you would like to look and feel a year from now.
*
Visualizing your future helps you stay focused.
What is the best way I can hold you accountable?
*
Be as precise as possible.
Have you worked with a trainer before? If yes, explain what you liked and disliked.
*
This allows me to structure a program which is fun and avoids things you dislike.
Please list and describe any injuries or ailments.
*
If you know the diagnosis please share.
Do you drink or smoke? If yes, what is your smoke or drink of choice and how often do you partake?
*
Specify how much and how often or type none if it does not apply.
Please list any supplements or medications you currently take.
*
Please be specific.
If you had one superpower what would it be and why?
*
Super powers are awesome!
Nutrition plan questions
Age
*
Height
*
Weight
*
Desired weight and when would you like to achieve this.
*
A realistic weight loss is 1-8 pounds per month and a realistic weight or muscle gain is 1-2 pounds per month.
How many hours of exercise do you complete each week?
*
None
1-3 hours
3-4 hours
4-6 hours
7+ hours
Daily activity level. Choose one of the following:
*
A) Sedentary (sitting most of the day, example: desk job)
B) Lightly active (mix of sitting/ standing throughout the day, example: teacher)
C) Moderately active (continuous standing and walking, example: restaurant server)
D) Heavily active (strenuous activity, example: construction worker)
Dietary preference.
*
Mediterranean
Vegetarian
Paleo
Vegan
Keto
Anything
How many meals do you eat per day?
*
Snacks count as meals.
Is there anything I can do to serve you better and help crush your goals more effectively?
*
I appreciate any/ all feedback!
After completing your purchase we will contact you shortly to schedule a date and time for your service.
My Products
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Virtual Personal Training
$50.00
$
50.00
One hour video call where I lead you through a workout. Exercise form will be assessed and feedback will be given in real time.
Body assessment
$50.00
$
50.00
One hour video call where I assess your entire body for muscle and skeletal imbalances. This is process allows me to further customize your workout plan and I recommend repeating this once every 4 to 6 weeks.
Workout Plan
$50.00
$
50.00
Four week customized Google Docs workout plan. You will have lifetime access to the docs and all current, past, and future plans will be viewable at anytime.
Nutrition Plan
$30.00
$
30.00
Three month flexible macro nutrient based plan. You will receive a comprehensive 17 page PDF which will cover your ideal daily nutritional needs to crush your goal. Food and meal examples will be included. Recommended to reassess every 3 to 6 months or when progress plateaus.
Brief Support Call
$20.00
$
20.00
A 20 minute phone call where we briefly go over bits and pieces of the plan. Ideal for a quick check up and a brief Q & A. Writing down questions, comments, or concerns before the call is highly encouraged.
Comprehensive Support Call
$50.00
$
50.00
A 60 minute phone call where we cover the entire current plan and I answer all questions you may have. Ideal when maximum support is needed. Writing down questions, comments, or concerns before the call is highly encouraged.
Total
$0.00
$
0.00
Payment Methods
Choose from one of the PayPal options to
make your payment.
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