Nutrition/Exercise Coaching inquiry form
Hello, thanks for your inquiry! I'm Matt Kostek, Personal Trainer and Nutrition Coach. Below is a brief form containing some basic questions I ask of all who inquire about my services. Answering these few questions (okay, about 10 questions but they’ll be short I promise!) gives me a better idea of how I can best be of service.  Please be sure to leave your contact info at the end of the form so I can get back to you promptly!
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What is your name? (nicknames okay, whatever you like to be called!) *
When were you born? *
MM
/
DD
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YYYY
How did you hear about my services?  (If someone referred you, please tell me their name)
What do you do for a living? *
How committed are you to making changes in the following behaviors? *
Not interested in changing
Considering making a change but not ready to commit yet
100% committed to changing
Exercise/physical activity
Diet and/or eating habits
Managing stress
Sleep
Over the past 3 months, how many days per week, on average, did you perform the following types of exercise? *
I've never done this before
<1
1-2
3+
Resistance training (free weights, bands, strength machines, body weight)
Cardio (running, cycling, hiking, swimming)
Interval training (HIIT, circuit training)
Aerobics (step, cardio kick, zumba, spin, barre)
Mind/body awareness (yoga, tai-chi, barre, qigong)
Sports (baseball, basketball, hockey, etc)
Something else
I operate under the philosophy that lasting change is accomplished slowly and incrementally through committed, consistent work.  There is no magic supplement, pill, wrap, cleanse, special food, diet, or fast and easy way that will enable one to make the lasting change they desire.  Is this in line with your own beliefs? *
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