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NEW CLIENT APPLICATION
CONTACT INFORMATION
Are you currently interested in 1:1 Fitness / Nutrition / Lifestyle coaching?*
Gender (There's only 2, no offense but if you don't agree, I'm not the coach for you*
*
Female
Male
Street Address (Used for giveaways)*
Country
PHYSICAL INFORMATION
What is your current health or fitness-related goal?
What diets have you tried in the past? Did you enjoy it? Did it work for you?
What is your current exercise routine, daily activity levels? Do you have any exercise-related goals?
Physical or Medical limitations? Both long-term or short-term (Diabetes, Thyroid, spinal fusion, Recovery to surgery, etc)
Prescriptions / Medications?
Do you currently track calories or macros consistently?
If Yes to the previous question, what is your current daily intake?
What are your food preferences?
How long ago was your last blood work?
How commited are you? Coaching plans start with a 3 month commitment
Very little commitment
Some commitment
Medium commitment
I'm pretty commited and ready to go
Let's get fricken started!
How commited are you? Coaching plans start with a 3 month commitment
Are you willing to submit a weekly assessment?
*
Yes
No
Do you understand that CHANGE requires CHANGE?
*
Yes
No
Do you view this as an investment into yourself?
*
Yes
No
What is your why? (Please be as descriptive as you'd like)*
What do you feel is your biggest struggle, both currently and in the past?*
Submit
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