Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Gender
FEMALE
MALE
Which Program are you Interested In
*
1:1 Coaching - Training & Nutrition
1:1 Coaching - Training ONLY
1:1 Coaching - Nutrition ONLY
What are your short term goals?
What are your long term goals?
How do you want to feel when you finish your program?
What are the areas you would like to see the most progress in?
What is your experience with working out / current level of exercise?
What is your current nutrition like?
Do you have experience tracking your nutrition? Calorie tracking / Macro tracking?
How do you feel on a 0-5 scale about your appearance?
What is your stress level like on a typical day/week?
How do you feel on a 0-5 scale about your overall health
Have you been on any form of a diet in the last 6 months, if so explain.
Do you have any food allergies or dietary restrictions?
Do you have any current or past illnesses deficiencies, or diagnosis that i should know about?
Any history of heart conditions?
Have you ever been diagnosed with Asthma or any respiratory disorder?
YES
NO
Do you feel chest pain with physical activity?
YES
NO
Do you have any current injuries?
Are you currently pregnant or trying to become pregnant?
YES
NO
When was the last time you got your bloodwork done? Have you received a hormone panel and thyroid panel?
Do you use any form of tobacco or nicotine products?
YES
NO
What are your favorite foods?
What is your go-to easy meal for a busy day?
What made you ready to commit to coaching?
How is your sleep schedule and how much sleep do you get per night
What do you do for a living, are you on your feet or sedentary?
Tell me about your schedule and lifestyle. What does a week in your life look like?
How many days a week can you REALISTICALLY commit to working out?
1
2
3
4
5
Will you be using a home gym or going to a gym?
HOME GYM
GOING TO A GYM
If home gym please list all equipment you have access to
if going to a gym, leave blank
What are some obstacles, behaviors, or activities that could potentially slow your progress. Lets dive deep here. I can only be the best help to you on this journey if i know where your weaknesses may be. This can be time management, dieting, accountability, anything.
Tell me something about YOU! Favorite foods, music, hobbies, anything!
Questions / Comments / Any additional info.
