Client Intake Form
Please take a few minutes to fill this out and let me know more about you! I offer one-on-one coaching for busy professionals who are ready to invest 3 months into their fitness goals.

Fill out this form
Schedule a personal phone call with me
Discuss your specific goals and formulate an action plan

Email address *
First and Last Name *
Cell Phone Number *
What do you struggle with the most related to your health and fitness? *
What are your top 3 goals that you want to achieve with me? *
How ready are you to commit to yourself? *
Not ready
Ready to Win
My one-on-one coaching is for those who are serious and can invest their energy into themselves and their health. Can you make the financial and emotional investment into my coaching? *
Have you worked with a health and wellness professional before? *
If you are accepted into my program you will be offered the opportunity to sign up immediately! Do you have the financial means to invest into your health? There is a financial commitment associated with working with me. *
Does anyone else (Spouse/parent) need to be included into this financial decision? *
What is your favorite meal/food? I love a good steak but Chips and Salsa is hard to beat too! *
What is your favorite movie? I'm a big fan of any sports movie, A Few Good Men, and Most of Pixar! *
Do you understand that no magic pill, wrap, juice cleanse, or tea will get you to where you want to be, and that hard work is needed to get you to your goals? *
By submitting this form, you will be entered into my email list. Understand you can unsubscribe at any time. *
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