Online Coaching Form
If you've gotten this far I know you feel frustrated with where to start or how to get to the next stage.

Congratulations on deciding to take the first step in your transformation. I can't wait to help you unlock your full potential and change your body and mind. First things first, I need to learn a little bit more about you, your goals, and your lifestyle to best design a program that meets your exact needs. I offer HIGHLY committed individuals the opportunity to take advantage of two different coaching packages which are for all ages and fitness levels whether you're training at home or a gym. The coaching packages are:


GET FIT PLAN: (4 or 12 week packages)
Five Workouts per Week
Grocery Shopping List
Supplement Guidance
Nutrition Guidance
Strength and Conditioning Programs
HIIT Programs for At-Home or Gym
Bi-Weekly Accountability Check-ins
Unlimited E-mail Access
4 Weeks: $120. 12 Weeks: $300

NEXT LEVEL PLAN: (4 or 12 week packages. Only available for DMV residents)
Five Workouts per Week
Grocery Shopping List
Supplement Guidance
Nutrition Guidance
Strength and Conditioning Programs
HIIT Programs for At-Home or Gym
Bi-Weekly Accountability Check-ins
Unlimited E-mail Access
1 hr In-Person One-on-One Session/ month
4 Weeks: $180. 12 Weeks: $480


Buckle up because this will not be your average training guide experience where you buy an online program and who knows if you ever complete a single workout. These workouts will be tailored for your specific needs. Week 1, you will receive a complimentary goal alignment session and complete a series of baseline strength and conditioning tests to efficiently benchmark your progress and hold you accountable to making progress. This is a very high-touch, performance-based training experience and I will be with you on-demand every step of the way to ensure you stay motivated and on track.

The first step in this process is filling out the below application to see if we are a good fit for each other. Please take your time and be as thoughtful and thorough as possible with your responses. The more detail you provide, the better I can "get to know you" and eventually deliver a program that best meets your needs.

After the form is submitted, I will review your answers and will reach out via email to set up your complimentary Goal Alignment Session and discuss the program in more detail.

THANK YOU again for your interest in my coaching services and I can't wait to help you look and feel like the champion you are!

-Jamaal Piper
Email Address *
Your answer
Full Name *
Your answer
Phone Number *
Your answer
City, State *
Your answer
Gender *
Age *
Your answer
Height *
Your answer
Weight *
Your answer
Do you have any dietary restrictions? *
Occupation *
Your answer
Describe your daily activities: *
Please list THREE goals. These can be a number on the scale, a look, a feeling, something health related - what are you working towards? *
Your answer
What is your WHY? Your WHY is your deeper meaning, cause or belief that inspires you. It is your driving force behind your goal. *
Your answer
What has been your biggest hurdle or obstacle you have faced during your fitness journey? *
Your answer
Have you ever worked with a coach before? If so, how was your experience?
Your answer
Do you have access to a gym? *
Have you ever played a sport? If yes, what sport? and at what level? *
Your answer
Which of the following best describes your body type? *
Have you ever had any injuries or chronic pain? (If YES, please explain.) *
Your answer
Have you ever had any major surgeries? (If YES, please explain.) *
Your answer
Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? (If YES, please explain.) *
Your answer
Describe your current stress levels *
No stress at all
Extremely stressed
How many hours of sleep do you average each night? *
Your answer
How committed are you to investing in your best self? *
Which program are you willing to commit to at this time?. *
Is there anything else you'd like me to know about you? *
Your answer
What is your instagram handle? *
Your answer
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