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CLIENT APPLICATION
Application submissions are required for your initial consultation call. Please answer each question with honesty so we can best assess whether we can assist in your transformation.
27
Questions
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1
About Next Level Fitness Academy
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2
Name
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First Name
Last Name
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3
Location
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Street Address
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City
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Alabama
Alaska
Arizona
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California
Colorado
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District of Columbia
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Texas
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Vermont
Virginia
Washington
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Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
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Ethiopia
Falkland Islands
Faroe Islands
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France
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The Gambia
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Israel
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Kosovo
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Laos
Latvia
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Lesotho
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Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Phone Number
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Area Code
Phone Number
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5
Email
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example@example.com
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6
Instagram Handle
If you do not have IG, put N/A
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7
Age
*
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8
Occupation
*
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9
What is your current height and weight?
*
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Height
Weight
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10
How did you find Next Level Fitness Academy?
*
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Facebook
Instagram
TikTok
Referral
You Know Coach Chad Personally
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11
If referred, who referred you?
Full Name
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12
How long have you been following Coach Chad/Next Level Fitness Academy on social media?
*
This field is required.
Please Select
Less than 6 Months
6-12 Months
Over 12 Months
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Please Select
Less than 6 Months
6-12 Months
Over 12 Months
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13
Why is "NOW" the time for change?
*
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14
What are your goals for this program? Be specific.
*
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Are you looking to get to a specific weight? Build muscle? Have more energy? Build better health habits?
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15
Have you tried other fitness programs or diets in the past? If yes, why haven't they worked out for you or what challenges did you face?
*
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16
Slide the scale for your current level of body confidence.
*
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Not Confident at All
Somewhat Confident
Confident
Very Confident
Extremely Confident
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Not Confident at All
Somewhat Confident
Confident
Very Confident
Extremely Confident
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17
How committed are you to starting a new health journey?
*
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Satisfied with where I am at
Somewhat satisfied with where I am at
Not sure where I am at
I'm willing to put in some work
I'm 100% committed to reaching my goals
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Row 0, Column 1
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Satisfied with where I am at
Somewhat satisfied with where I am at
Not sure where I am at
I'm willing to put in some work
I'm 100% committed to reaching my goals
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
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18
How much money are you spending per month on conveniences that aren't serving you?
*
This field is required.
Carryout, Dining Out, Fast Food, Convenience Foods, GrubHub/DoorDash, Alcohol
Please Select
Less than $100
$100-$199
$200-$299
$300-$399
$400-$499
More than $500
Please Select
Please Select
Less than $100
$100-$199
$200-$299
$300-$399
$400-$499
More than $500
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19
Do you have any special events coming up in your life that you'd like to look and feel better for?
*
This field is required.
Wedding, vacation, reunion, anniversary, 40th birthday, etc.
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20
What would you expect from your coach if you're accepted into Next Level Fitness Academy?
*
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21
We only take on a specific number of clients per month to ensure adequate time is available to work with each client. Why do you think you would be a good addition to our program?
*
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22
Next Level Fitness Academy is about teaching, not just ordering you around. We'll teach you how to be in control of your health and fitness, while gaining confidence through a structured program customized for YOU. Are you ready and willing to invest in your health and be committed to this program?
*
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YES
NO
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23
Next Level Fitness Academy is not a free program. Do you have the financial resources to invest a minimum of $500/month to reach your health and fitness goals?
*
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YES
NO
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24
Will you need someone else (spouse/partner) to be part of the financial decision in moving forward with Next Level Fitness Academy?
*
This field is required.
Anyone involved in the financial decision making will be REQUIRED to be on the call.
YES
NO
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25
Do you participate in a HSA/FSA account?
*
This field is required.
Qualified individuals get reimbursed
30% on average
with Next Level Fitness Academy by using their HSA/FSA.
YES
NO
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26
If accepted, how soon are you looking to get started?
Remember, those who don't take action are 95% more likely to stay in inaction!
Please Select
ASAP
1-2 Weeks
Next Month
Not Sure
Please Select
Please Select
ASAP
1-2 Weeks
Next Month
Not Sure
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27
I realize I'm booking a real time slot with you.
*
This field is required.
Coach Chad will reach out to schedule this appointment time with you directly.
YES
NO
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28
I will be available to take the call in a quiet, distraction-free environment at our agreed upon time.
*
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YES
NO
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