Consultation Questionair

Ultimate Remote Health & Nutrition Coaching Program

$275/month | Minimum of 2 months commitment.
This program offers the highest level of personalized coaching, designed to help you achieve your fitness and nutrition goals. Here’s what you can expect:
- 1-on-1 Personalized Coaching: Tailored health, fitness, and nutrition plans customized to your goals, fitness level, and lifestyle.
- Regular Check-ins: Ongoing communication and accountability through scheduled check-ins, ensuring you stay on track and make consistent progress.
- Flexible & Remote: All coaching is done remotely, giving you the flexibility to train and follow your nutrition plan on your schedule, from anywhere.
- Progress Tracking & Adjustments: I'll monitor your progress closely and adjust your program as needed to keep you moving forward.
- Comprehensive Support: Guidance in all areas—nutrition, fitness, and lifestyle changes—so you can transform your body and health.
Personal Information
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Instagram/Facebook Name
Age*
years
Height*
EX. 5' 2"
Current Weight*
LBS
Ideal Weight*
LBS
Gender*
Goals & Motivation
Tell me a little bit about yourself...
What are your top 3 fitness or health goals?
ex: weight loss, strength building, improving energy levels, etc.
What has motivated you to seek coaching at this time?
What's your "why"
Health & Fitness Background
What is your current fitness level?

BeginnerIntermediateAdvance
Do you currently have a fitness routine? If yes, what does it look like?
Have you trained with a personal trainer or online coach before?

YesNo
If yes, what kind of training did you do?
What kind of exercise do you enjoy most?
Do you have any specific health concerns such as illness, pain, injuries, etc?
Nutrition & Lifestyle
How would you describe your current diet?
ex: balanced, inconsistent, specific diets like keto, etc.
What nutrition challenges are you currently facing?
ex: overeating, emotional eating, lack of knowledge, etc.
What does a typical day of eating look like for you?
Readiness & Commitment
Are you ready to commit to making changes in your fitness and nutrition?

YesNot Yet
Are you willing to commit to a minimum of 2 months of coaching?

YesNo
Expectations & Preference
What do you think you need most in order to achieve your goals? (check all that apply)*

Accountability & ConsistancyEducation & GuidanceCommunity SupportOtherA Set Plan
Why are achieving these goals important to you?
What results would make you feel successful at the end of this program?
How did you first find about my program?*

InstagramFacebookTikTokAn Ad (thumbtack,/google/FB/IG)RefferalOther
I understand that this program requires a minimum 2-month commitment.*

I understand
I understand that results require dedication and consistency.*

I understand
Congratulations on taking this important step for your health! 🎉 I’m excited to work with you, and I’ll be in touch soon to schedule your program onboarding call. Get ready to start your journey toward achieving your goals!
Should be Empty:

Ultimate Remote Health & Nutrition Coaching Program

Personal Information

Goals & Motivation

Health & Fitness Background

Nutrition & Lifestyle

Readiness & Commitment

Expectations & Preference