Coaching Questionnaire
Please fill out in full
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Tell me something unique about yourself :
*
What are the 2-3 biggest things you want to feel change while working with me ?
*
How is your daily energy on a scale of 1-10 ? ( 10 being great )
*
How would you describe your habits and routines
*
Healthy and consistent
Mediocre
I haven’t established any good habits
I have a lot of poor habits
What are you seeking in a coach ?
*
Please describe your current level of physical activity & exercise/training programming if applicable in detail:
*
Please describe eating habits / macros / total calories consumed per day. If not tracking put N/A
*
Is there anything else we should know about you, your health , lifestyle and/or goals ?
Are you the primary decision maker ? ( if not primary must be present during our meeting )
*
Yes
No
What is your annual income ?
*
Under 50k / yr
50k - 75k /yr
75- 100k year
Over 100k
Are you CURRENTLY willing to make a significant financial investment in yourself ?
*
Yes I have cash flow
Yes I have credit but not cash flow
No I do not have cash flow or credit
Submit
Should be Empty: