Coaching Interest Application
Thank you for your interested in working with me.
Please complete the following coaching application to the best of your ability providing as much information and transparency which will allow me to determine if you might be the best fit for my coaching services.
If you want to know more about my coaching services check out my website -
https://med3fitness.com/online-fitness-nutrition-coaching/
* Required
Email address
*
Your email
Address (optional)
Your answer
Full Name
Your answer
Phone Number
Your answer
Where do you live? (state or country) Include timezone
Your answer
What specific days and time ranges would work best for you to have a coaching call?
Your answer
Gender
*
Male
Female
Age
*
Your answer
Height
*
Your answer
Current Weight
*
Your answer
Goal Weight
*
Your answer
Medical Issues or other concerns
No Medical Issues
Hypothyroid
Hashimoto
Hyperthyroid
PCOS
Nursing/Pregnancy
Peri-Menopause
Menopausal
Post Menopausal
Diabetes
Gastic Bypass or Lap Band
Eating Disorder
Binge Eating (current or in the past)
Other:
Activity Level
*
Sedentary: No exercise, maybe 1 - 2 days of activity, very little movement.
Light Activity: Desk job, with 2-3 days of activity or exercise per week.
Active: Standing job (server, teacher, nurse) with 4-5 days exercise per week.
Very Active: Manual labor (dancer, mechanic, landscaper) with 6-7 days exercise per week.
High Active: Intense manual labor (farmer, mason, roofer) with 7 days exercise per week.
What do you do for work and do you mostly stand or sit?
Your answer
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