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cLean Life Fitness Consultation Form
Hello & welcome to the Clean Life Fitness Consultation. I am launching a new program this January I’m super excited about with limited spots. For that reason I’m announcing this form early.

“Holistic Fitness & Emotional Empowerment”
A unique program that integrates fitness training, nutrition guidance, and emotional intelligence coaching to help people not only look better, but feel more confident, resilient, and fulfilled.

⸻

🪜 Core Framework

1. The Five Pillars
• Consistency
• Patience
• Resilience
• Mindset
• Faith

These act as the foundation for both physical results and personal growth.

2. Emotional Intelligence in Fitness
• Teaching clients how to understand their triggers (stress eating, negative self-talk).
• Helping them regulate emotions and channel energy into productive workouts and meal planning.
• Building self-awareness that connects body cues (hunger, fatigue) with emotional balance.

3. Confidence Through Action
• Structured wins in the gym + meal plan adherence = small victories that compound.
• Reinforcing confidence by showing clients how discipline in fitness spills over into career, relationships, and self-love.
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Name / Age *
Height/Weight *
Phone / Email *
What are your fitness goals that you’re trying to reach? Be specific, numbers are not everything. Search more into how it will make you feel. *
When it comes to nutrition.. what foods do you find yourself craving? Do you have structured meals you have each day or meals you have most days? If you were to have a meal plan or a macro based approach what are some non negotiable foods you’d like to have in your plan? *
What is your current exercise routine? If you don’t have one and go with the flow that’s totally fine! Just provide me what you’re currently doing.. what you’d eventually like to be able to do.. what you’ve done in the past! Timeline is helpful. *
When trying to hit said goal, what are your main struggles? *
Now that we have your goals and struggles. An important questions I like to ask is.. what is your why? Why do you want to accomplish this? *
If you have any illnesses or injuries please list them below, and consult with your medical provider prior to working with me. Thank you! *
If Coach Josh could provide a solution to you that could solve everything with his guidance, would you take this opportunity seriously?
Not that serious
Very Serious
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