Join the Breakthrough Blueprint!
Hello hello! We are SO excited to join the Breakthrough Blueprint starting November 13th.

By filling out this form you are securing your spot with us. After submitting this form, you will receive an invoice for $247 as well as an email from us with next steps.

PLEASE make sure your email is typed in correctly and please check spam if you don't see an email in your inbox within 48 hours of filling this out.

If you have any issues, questions, comments, or concerns please let Alicia know at alicia@thefitbreakthrough.com

THANK YOU!


Sign in to Google to save your progress. Learn more
What is your name?  (First and last) *
What's your email? *
What's your age? (must be 18 or older) *
What is your height/current weight? *
What are your main goal you're seeking right now? Please write any mental and/or physical goals. *
What is the biggest thing stopping you right now from reaching that goal? *
Do you know your current average food intake (could be calories or macros?) If not put N/A, if so please specify. *
Have you ever tracked macros before? *
During your first week we can give you macro targets if you choose to track. Do you have an interest in tracking macros and receiving them as a part of your starting protocols? (If you've never tracked macros before we will also provide you with resources on how to track) *
What is your current cardio routine? Feel free to write how many minutes per week or per day. Please specify the type of cardio as well. *
What's your average step count per day? (You can find on the iphone health app) *
Do you currently lift weights? If so, what's your current routine and how many days per week do you lift? *
Are you currently on birth control? if so, what kind? *
What is your current job/ student status? *
How would you rank you overall stress levels? *
Not stressful
Extremely stressful
How many hours of sleep do you get most nights? *
How many nights a week do you usually consume alcohol? *
How would you rate your current relationship with food? *
Poor
Ideal
We offer at home or gym workouts. Would you like to get at home or gym workouts during these next 7 weeks?
The at home workouts will be dumbbells and bands only.
*
Do you have any dietary restrictions or health complications? *
What supplements or vitamins are you currently taking if any? *
On a scale of 1-10 how comfortable do you feel in the gym? *
Not confident
Very Confident
By filling this out, you agree to the one time payment of $247. You also acknowledge that you will be assigned a coach to give starting protocols based on where we believe you will be the best fit. Our coaches are Alicia, Evelyn, and Laura. *
How did you find us? *
By filling this out, you acknowledge that this is small group coaching and that this is different than our full 1:1 coaching offer. This will include the following:

- Access to our training app with either a gym split or at-home workouts (NOT custom workouts, these are pre-made workout splits)
- Group chat with all the other small group coaching members and all three coaches to ask questions/talk/support
- Every other week zoom calls
- The option to attend 2 office hours per week with Coach Alicia
- Starting video protocols from your coach
- Check ins/protocols every other week with your coach focusing on habits and non-negotiables
- Over 150 educational materials including meal ideas and video trainings in our client resource database
*
Anything else you'd like to add? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy