Client Application Form

1

Are you interested in getting in control of your body and the way it look? (this is what we do, so I just want to make sure)* This field is required.

YESNO

2

What body type are you coming to us with? (select all that apply)* This field is required.

Skinny - needs to add more tone

Skinny fat - I am in a soft fluffy middle ground

Medium - I look fairly normal I would say

Chubby - I am soft around all the edges

Overweight - definitely overweight for my height and body structure

Obese - I am more than 50lbs overweight

Bottom heavy - top is toned but legs are not

Top Heavy - legs are toned but upper is not

4

Do you have any experience with macronutrients tracking?* This field is required.

Advanced

I know a thing or two

Beginner

Tried but couldn't figure it out

5

The macronutrient approach is an overall approach to food that, when used correctly, gives you immense control over your body composition. Read the benefits below. Are you interested in achieving these benefits? * This field is required.Benefits:Controlling your body and the way it looks. Sustainable and long term approach. Flexibility of still eating foods you enjoy. Living life without second guessing your diet

YESNO

6

Which of the following describe your current situation best?* This field is required.

I am trying really really hard with my workouts and diet but I can’t get toned for the life of me. No matter what I do, I still have a soft fluffy look.

I have no idea anymore when it comes to my diet, macros, and all around nutrition. Everywhere you go, someone is saying something different. I have no problem putting in the work. I just want to know I am doing the right thing.

I was out of shape and began to make progress and now my results have stopped and it’s become disheartening. I don’t want to fall out of shape again but it’s becoming hard for me to keep pushing forward when I’m no longer seeing results.

Food controls me. I am so unsure about what I should be eating and if I’m doing the right thing that every morning I wake up, I feel a sense of worry/dread. It’s unhealthy and I want to fix it.

I feel like I'm on a roller coaster. I can get in shape but I do it in ways that break me down over time and can’t sustain. I want to learn something that can last long term.

I have been out of shape for a while now. I need a full reboot. I need you to believe in me because I am not sure I do anymore.

I feel like I am already in pretty good shape. I just want to take things to the next level. I have pushed my experience to the limits of where it can take me and I’m looking for more.

I am really uncomfortable in my skin and it’s beginning to wear down my confidence levels and starting to have a downward impact on other areas of my life.

7

How committed are you to solving this problem today?* This field is required.

4 out of 10 - I don’t want to improve my situation that much and I am ok not making more progress than I have now.

6 out of 10 - I am pretty frustrated with things right now and want to change things, but also afraid I'll fail.

8 out of 10 - This is affecting my confidence, energy, moods, and how I am showing up in all areas of my life. I want to fix this ASAP.

10 out of 10 - I will literally do anything to get this under control. (safely!) I don’t want to go another day without sustainable healthy, long term program that will improve my body composition and make me feel better. I am committed to doing this and I am ready, able, and willing to put in the work.

9

Where would you like to be 6-12 months from now? (select all that apply)* This field is required.

I want to feel like I am in control of my body and the way it looks.

I want to feel free from food and the mental chatter that comes with not understanding it.

I want to feel like I can do this myself, and am not dependent on a trainer / nutritionist.

I want to drop 10-15 lbs of fat

I want to drop 25+ Ibs of fat

I want to add lean muscle tone & see sculpted shoulders/legs/arms etc

I want to enjoy a body that I feel proud of and not avoid mirrors for the rest of my life

I want to live a healthy lifestyle that deserves respect.

10

What is holding you back from achieving these goals? (select all that apply)* This field is required.

I have a hard time sticking to a diet... I think because I have a hard time believing it'll work long term.

I can stick to a diet, they just always stop working after a certain point, and then I quit them.

I have no problem putting in the work, I just am not sure what I am supposed to do!

I have trouble trusting the process and need something full proof that I can understand myself.

I don't have the right knowledge. The confusion is causing inaction and I am done with it.

I have a hard time committing and need a heavy element of accountability & support.

I don't have a community or people around me who think like me and can support me.

I don't have any expert coaches, or advice that helps me get back on track.

11

What stage of menopause best describes where you are currently?* This field is required.

Still having regular cycles monthly & no signs or symptoms of hormone changes yet

Perimenopause - some signs & symptoms beginning and mild changes in cycle length or frequency

Cycles have ceased within the last 3-9 months

Full on menopause/post menopausal (a full year or longer without a cycle)

Medically induced menopause at some point in life (via cancer treatments or full hysterectomy)

12

Please share any other things you think are your big obstacles holding you back from your health and fitness goals.* This field is required.

13

What are the most important goals you want to reach with your fitness? And please explain why you are seeking coaching help from Free to Be Me?* This field is required.

14

Are you willing to communicate and engage in the process, understanding that this is a partnership where you and your coach are CO-creating this experience together to ensure the best possible outcome?* This field is required.

YESNO

15

Would it be worth it to you if it took a full year to get there? Knowing you'd have every tool you could need in your toolbox for the rest of life?* This field is required.

YESNO

16

Do you believe in the return on investment for improving your physical and mental well being?* This field is required.

YESNO

17

Do you believe that accomplishing your goals would improve other areas of your life outside of fitness?* This field is required.

YESNO

18

Are you prepared to take action RIGHT NOW to invest the time, energy, and finances in yourself to reach your goals if you knew with 100% certainty that you would get there? * This field is required.

YESNO

19

If you're accepted into our program how soon can you get started?* This field is required.

Right away, the moment I'm accepted!

Within a week of acceptance, due to travel/sick/work

Not sure, I need to plan ahead for when "things slow down"

20

Name* This field is required.

First Name

Last Name

21

Age* This field is required.

22

Email* This field is required.

example@example.com

23

Phone Number* This field is required.

Please enter a valid phone number.

24

Best time of day to reach you?* This field is required.