New Client Form

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New Client Form

Welcome! Please fill this form out to the best of your ability so we can start working together!

Let's get strong together!

Name *

What are your pronouns?

Date of Birth
(This is only used to determine if you are 18 years of age or older and will not be shared with anyone unaffiliated with me) *

YYYY

Current Job *

Best email to reach you *

Are you looking for online coaching or 1:1 coaching at Emerge Fitness? *

Online

1:1 at Emerge Fitness

1-time programming (8,12,16 week plans)

Budget that is doable for you (per month) (select all that apply)
(this will determine frequency for calls or check-ins if preferred)
This is for online coaching! *

125-150

175-195

205-225

225-275

Other

Chat with me about a sliding scale (For low-income, queer, disabled, and BIPOC)

Required

I am prepared to make the financial commitment of hiring a coach at this time and have reviewed the pricing of my above selection *

I have read and agree to the above statment

Are you willing to commit to 3 months of training? *

Yes

I am not sure with budget/other life factors (we can chat about this)

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