Client Application Form
First and Last Name
Date of Birth & Age
Estimated Percentage of Body Fat (if you don't know just put "unknown')
Fitness Goals (list three)
What's your biggest challenge(s) right now? In other words, what do you think is keeping you from reaching your goals?
Do you have any injuries or other concerns that I should be aware of? (please list)
How did you hear about me? (just curious)
Do you play any recreational sports?
How would you rate your current physical condition?
Very Active/Athletic (exercise 4+ times per week)
Somewhat Active (exercise 2-3 times per week)
Not Active/Couch Potato
Do you have a dietary preference?
Omnivore (i.e., plant & animal based products)
What are some of your favorite foods?
Do you have any favorite exercises?
Which one of my premium coaching program are you interested in?
One-on-One Online Coaching Program (12 Weeks)
Hybrid Coaching Program (includes in-person training with me) (12 Weeks)
Small Group Online Coaching Program (6 Months)
Why do you want to be part of my premium online coaching program?
Are you willing to commit to a 12 Week Program?
If we were to work together, where would you be training?
Local Recreational Center
Apt. Building Gym
On a scale of 1-10, how committed are you to achieving your health and fitness goals?
I love lying on my couch :)
I would run through a wall
Is there anybody else who may be involved in your decision to hire me as your coach or stick to a fitness program?
Send me a copy of my responses.
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