1:1 Online Coaching Application
Thank you for your interest in working with me! Please answer the questions below so I can assess your needs and goals.  Upon completion of this form, I will reach out to you to schedule a consultation call, where we will determine if we are a good fit and discuss in more detail what options are best for you!

I am looking forward to getting to know you and to get started reaching your goals!

PS - this is for online coaching ONLY! If you are interested in in-person training sessions, please visit www.activelifelongbeach.com to book a discovery call.
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Email *
Full Name *
Phone Number *
Instagram Handle
How did you hear about me? If someone referred you, please tell me - I would LOVE to thank them! *
Why have you chosen to work with me? *
Date of Birth *
Age *
Gender *
Height (feet, inches) *
Current Weight (lbs.) *
Tell me about yourself. What do you do for a living? What is your daily life like? *
What is the activity level at your job? *
Do you participate in activities outside of work or the gym? If so, please list them. *
Do you have any diagnosed health problems? If so, please list your condition(s). *
Do you have any current or prior injuries I should know about? If so, please list them *
Please list any medications you are currently taking for any current health condition(s) or injuries. *
Are you a current tobacco smoker? *
How is your prior experience with exercise and nutrition? Have you ever worked with a coach before? If so, what were your likes & dislikes? *
What are your fitness goals? Check all that apply. *
What does your current diet and exercise routine look like? *
How often do you currently workout? *
Rate your ability to perform cardio exercises *
Very Low
Rate your experience with weight lifting *
How frequently do you have time to exercise? *
What do you think you need most to achieve your goals? *
What are some things that have worked or didn't work for you in the past? What struggles have slowed down your progress on your fitness journey? *
Are you willing to spend a few hundred dollars per month (minimum of 3 months for online coaching) to make this physical, mental & financial investment in your health & fitness? (PS. We will discuss all of the pricing options on our call!) *
Does anyone else need to be apart of this decision?  If so, please speak with them before to know where they stand on this decision. *
What is your availability like for a consultation? *
Any other comments or questions?
A copy of your responses will be emailed to the address you provided.
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