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Application Form
Hi!
Thank you so much for applying to work with me. I am so grateful and aim to never take for granted that my clients trust me with their health. What an amazing gift and responsibility!
Please fill out each question as thoroughly as possible. The more information I have the better!
I will reach out to you within 48 hours to schedule a 30 minute introductory meeting once you submit this form.
I look forward to working with you! :)
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Hey! What's your name?
Your answer
What's your email?
Your answer
When were you born?
MM
/
DD
/
YYYY
How tall are you?
Your answer
What is your current weight?
Your answer
What is your phone number?
Or how can I reach you?
Your answer
In general, what are your goals? Check all that apply
Lose weight/body fat
Gain weight
Maintain weight
Add muscle
Improve overall health
Look better
Feel better
Have more energy and vitality
Get control of eating habits
Get stronger
Improve athletic performance
Other:
How, specifically, would you like your habits, your health, your eating, and/or your body to be different?
Your answer
Out of all the changes you'd like to make, which one feels the most important/urgent?
Your answer
Why is achieving this goal important to you?
Your answer
Why are you deciding to take action now?
Your answer
In the past, what has prevented you from achieving your goals?
Your answer
What is your activity level?
Sedentary (I don't currently exercise)
Light (1-3 hours of exercise or sports per week)
Moderate (4-6 hours of exercise or sports per week)
Heavy (Heavy labor job, multiple 1+ hour workouts per week)
Clear selection
Do you currently exercise?
Yes
No
Clear selection
How many years of weightlifting experience do you have?
0
1-2
3-4
5+
Clear selection
Which of the following equipment do you currently have access to?
Full gym
Partial/Home Gym
No equipment
Other
Which of the following, if any, do you have?
Body weight scale
Food scale
Soft/Flexible measuring tape
How many hours per week are you willing to invest in your fitness/health?
Less than 3
3 to 5
More than 6
Clear selection
How many hours do you sleep each night
4 or less
5
6
7
8
9
10+
Clear selection
Have you every purchased or tried any health/fitness programs in the past? Have you ever worked with an online coach? If so, how would you describe your experience? What were your likes and dislikes?
Your answer
Right now, how would you rank your overall eating/nutrition habits?
Horrible
1
2
3
4
5
6
7
8
9
10
Amazing
Clear selection
Why did you give that score?
Your answer
Have you tracked calories/macros?
Yes
No
I currently do
Clear selection
Describe a time where you've felt the most content/happy/healthy with your weight or body.
Your answer
Who lives with you? Check all that apply
Spouse or partner(s)
Roomate(s)
Child(ren)
Pet(s)
Other family (e.g. parent, grandparents, sibling, etc.)
Other
Do you have children? If yes, how many and what are their ages?
If no, skip this one.
Your answer
Who does most of the grocery shopping in your household?
Me
Spouse or partner(s)
Roomate(s)
Child(ren)
Other family
Other:
Who does most of the cooking in your household?
Me
Spouse or partner(s)
Roomate(s)
Child(ren)
Other family
Other:
Right now, how much do the people and things around you support health, fitness, and/ore behavior change?
Not at all
1
2
3
4
5
6
7
8
9
10
Completely
Clear selection
How do you feel about your schedule, time use, and overall busy-ness?
Life is packed & insane
1
2
3
4
5
6
7
8
9
10
Life is calm & relaxed
Clear selection
Can you expand on why you chose that score? What's occupying your time?
Your answer
What is your typical stress level on an average day?
No stress
1
2
3
4
5
6
7
8
9
10
Extreme stress
Clear selection
How do you normally cope with your stress?
Your answer
How ready do you feel to make changes?
Not at all
1
2
3
4
5
6
7
8
9
10
Completely
Clear selection
How confident are you in making changes?
Not at all
1
2
3
4
5
6
7
8
9
10
Completely
Clear selection
What do you expect from me as your coach?
Be as detailed and specific as possible. I want to help you any and every way you need me to.
Your answer
What are you prepared to do to work toward your goals?
Eating habits, exercise routines, mindset shifts, etc. What will you do and what do you need the most help with?
Your answer
If we worked together, what would success look like to you?
Your answer
In very simple, practical terms, what is it that you need to achieve your goals?
Your answer
As we work together, questions may pop up. When you ask a question, how would you like me to respond?
It's important to note - there is no wrong answer here. Whether you just want to follow a plan or you want me to give you the answer to every why - I will accommodate you.
Keep it simple for me
1
2
3
4
5
6
7
8
9
10
I want every detail
Clear selection
What days have you set aside time for exercise?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What days work best for you to complete your weekly check-in?
Check-in feedback will be delivered within 24 hours unless you've chosen a day where this falls on the weekend.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
What time of day is best for you to receive reminders/updates?
Morning
Afternoon
Evening
Whenever
Clear selection
Any relevant injuries/pains I should know about?
Your answer
Do you have any medical conditions that could influence your exercise? If you're taking any medications, please list side effects relevant to exercise. Ex: dizzy upon standing
Your answer
Has your doctor given you permission to exercise?
Yes
No
Clear selection
Do you have instagram? If so, what's your @
Your answer
For a 30 minute introductory meeting to cover goals/expectations, would you prefer to meet via:
Video Call
Phone Call
Clear selection
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