Coaching Application
Please complete this form in its entirety. The more I know, the better I can help you achieve your goals.
Email address *
Name (First & Last) *
Your answer
Phone Number *
Your answer
Gender *
Age *
Your answer
Height *
Your answer
Weight *
Your answer
How would you rate your current physical condition? *
Please check all types of training you've done. *
Required
Do you have any food restrictions? *
Your answer
Do you currently track calories or have a food journal?
Your answer
How much water do you drink every day?
Your answer
I have trouble controlling what and how much I eat when feeling stressed, anxious, emotional or in certain social situations. *
Do you have any injuries or health concerns that may affect your ability to exercise? If yes, please explain: *
Your answer
If nothing changes in your life, what do you see happening in 5 years?
Your answer
What goals would you like to achieve within the next 2-3 months? (Be very specific) *
Your answer
What goals would you like to achieve in the next 6 months to a year? (Be very specific) *
Your answer
Why are those goals important to you? *
Your answer
What would be the smallest step you could take today to get closer to achieving those goals? *
Your answer
Tell me more about what you have going on in your life. What else do you have on your plate that needs to be taken into consideration?
Your answer
If you decided to change today and take steps toward your goals, on a scale of 1-10, how confident are you that you could change, when 1 represents not at all confident and 10 equals extremely confident? *
Not At All Confident I Can Change
Extremely Confident and I Will Take Steps to Change
Do you consider yourself a coachable person? Why or why not?
Your answer
Are you ready to financially invest in yourself, your health and hire a coach to help you attain your goals?
How did you hear about me? *
Your answer
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