Coaching Application
If you are interested in my coaching services and would like to enquire, please fill in the form below so I can determine how best to help with your goals and I will be in touch with your exact strategy.
Email address *
What is your name? *
What is your age? *
What is your gender?
Clear selection
Which City + Country do you live in?
What is your current weight?
If known, what was your lowest weight in the past 12 Months?
What is your occupation?
Do you work Night Shifts?
Clear selection
On Average, what are your total weekly working hours?
On average if known, how much sleep in hours do you get on a daily basis?
Do you currently track your caloric intake? *
If not, are you willing to start tracking your caloric intake?
Clear selection
If known, what are your current daily calories (and macronutrients ie. Protein, Carbs & Fats if also known)?
In years, how long would you say you've been training or exercising for? *
Do you have any injuries past or present that may affect your ability to perform an exercise? If so, please state below. *
If Yes, How often do you partake in exercise activities per week? *
In a short paragraph, Describe what you would like to achieve, whether it be exercise related, sports performance based, weight loss or health related. *
Do you have a specific time frame in mind to achieve your goal? If so, how long? *
Do you smoke?
Clear selection
Are you currently taking any prescribed medication that may affect your performance? If so, please state below. *
Do you have access to a workout space and if so, please select what type. *
Required
What attracted you to enquire about my services?
Are you willing to commit to the hard work and dedication it takes to achieve your goals? (You’d be surprised how many people get to this point and say no!) *
A copy of your responses will be emailed to the address you provided.
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