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New Client Form
Just a reminder that I am not currently taking 1:1 clients at the moment. As spots open up I will be reaching out to people in chronological order assuming we are a good fit :)
Filling out this form will automatically add you to my waiting list. If you have any questions I have a podcast linked below that explains everything...or you can always reach out via email or DM.
https://open.spotify.com/episode/0JEkvNdumOawWlXlUuPAmu?si=Y1KFBkWGRGSec0cyplKbeA
Thanks!
-JL
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Email
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Your email
1) First and Last Name
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Your answer
2) Sex
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Male
Female
3) Age
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Your answer
4) Height
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Your answer
5) Weight as of today
Your answer
6) Average hours of sleep per night?
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Your answer
7) Rate your sleep quality
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Toss and turn every hour. See every hour on the clock
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10
Sleep straight through the night rarely waking up
8) What is your PRIMARY goal?
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Fat Loss
Muscle Gain
Increase Strength
Sports Performance
Increase Overall Health
Other:
9) What is your SECONDARY goal?
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Fat Loss
Muscle Gain
Increase Strength
Sports Performance
Increase Overall Health
Other:
10) What is LEAST important?
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Fat Loss
Muscle Gain
Increase Strength
Sports Performance
Increase Overall Health
Other:
11) What are your short term goals - What do you want to achieve in the next 4-6 weeks?
Your answer
12) What are your long term goals?
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Your answer
13) Roughly how many steps do you get daily?
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Your answer
14) Are you currently training consistently?
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Yes
No
15) How many days per week do you currently train?
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Your answer
16) How many days per week do you WANT to weight train?
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Your answer
17) What is your ideal duration for a workout?
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Your answer
18) What type of weight training programs have you used in the past?
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Push/Pull/Legs
Upper/Lower Split
Body Part Split
Home Workout Tapes
Power Lifting
Olympic Lifting
Other:
Required
19) Currently, what does your week of workouts look like?
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Your answer
21) If you have any diagnosed health problems, please list them here.
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Your answer
22) If you are on any medications, please list them here.
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Your answer
23) Do you currently have any injuries?
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Your answer
24) How would you describe your level of activity at work?
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Office - I sit all day
Teacher - I stand, but not much activity
Moderate - I walk around a lot
High - Moving and grooving all day (construction, personal trainer etc)
25) What do you do for a living?
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Your answer
26) Socially, describe your average weekdays
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Happy hour? Movies? Netflix & chill?
Your answer
27) What do your weekends look like?
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Your answer
28) Describe your alcohol consumption.
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Amount, frequency, type of drinks you enjoy etc
Your answer
29) Do you prepare the majority of your meals?
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Your answer
30) How many meals do you typically eat each day?
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Your answer
31) Are you currently following a specific diet or nutrition plan?
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Yes
No
32) If so, what is the name of your diet or could you please describe it for me.
Your answer
33) What is your average daily caloric intake? (If you know)
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Your answer
34) Have you ever counted calories/macros before? If so, what was your experience like?
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Your answer
35) If you answered NO to #35: Are you familiar with what macros are? (serious question <3)
Yes
No
Clear selection
36) 1-10 How would you rate your knowledge of nutrition
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I'm just good at eating
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I count macros in my sleep
37) Select all that would be considered a high quality source of protein--this is NOT a test...I genuinely want to meet you where you're at so we can learn together <3
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Broccoli
Tofu
Pasta
Brown Rice
Chicken
Chickpeas
Greek Yogurt
Tuna
Asparagus
Black Beans
Beef
Egg whites
Required
38) How's your relationship with the scale? Do you ever weigh yourself?
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Your answer
39) Have you ever had another online coach? What were some likes/dislikes? How was that experience?
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Your answer
40) Have you ever had an eating disorder or thought you may have an eating disorder?
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Your answer
41) Do you have any food allergies? If so, what are they?
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Your answer
42) Would you rather:
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Make VERY FAST progress that you know IS NOT sustainable
Make A BIT SLOWER progress that you know IS sustainable
43) Please elaborate on your answer to #42
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Your answer
44) Favorite book(s)
Your answer
45) Favorite movie character
Your answer
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