ONLINE COACHING FORM

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I cannot wait to have you as a part of my community!

I’m honoured to be a part of your health, fitness and wellness journey.

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 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.

With love and light, Eden xx

Full name: *

Email: *

Date of birth: *

YYYY

Contact number: *

Occupation: *

How did you hear about EMK Wellbeing? *

Describe your daily activities: *

Sedentary: doing nothing all day like sleeping and watching TV.

Very light activity: doing nothing physical, like working a desk job without performing any type of physical activity during your day.

Light activity: having a non-physical job, but performing some sort of physical activity during the day, like walking, but no hard training.

Moderate activity: having a non-physical job, performing some sort of physical activity during the day, and including a daily workout session in your routine. This is where most of you are at

High activity: either training plus a physical job or non-physical job and twice-a-day training sessions.

Other:

Do you have any dietary restrictions? *

None

Vegan

Gluten Free

Vegetarian

Other:

Please list THREE goals. These can be a number on the scale, a look, a feeling, something health related - what are you working towards?
*

What is your WHY? Your WHY is your deeper meaning, cause or belief that inspires you. It is your driving force behind your goal.
*

What has been your biggest hurdle or obstacle you have faced during your fitness journey?
*

Have you ever worked with a coach before? If so, how was your experience?
*

Have you ever had any injuries or chronic pain? (If YES, please explain.)
*

Do you have access to a gym?
*

Yes

Have you ever played a sport? If yes, what sport? and at what level?
*

Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? (If YES, please explain.)
*

How many hours of sleep do you average each night?
*

Which of the following best describes your body type?
*

Ectomorph: Lean and long, with difficulty building muscle.

Mesomorph: Muscular and well-built, with a high metabolism and responsive muscle cells.

Endomorph: Bigger, high body fat, often pear-shaped, with a high tendency to store body fat.

How committed are you to investing in your best self?
*

I’m highly committed and have the financial means right now

I’m committed but do not have the financial means right now

Is there anything else you'd like me to know about you?
*

What is your instagram handle?

Thank you for completing my online coaching form. Please make sure to answer all questions and if you need anything in the mean time feel free to send me a message via Instagram or phone. I will get back to you as soon as possible! Have an amazing day! x

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