1:1 coaching application
So excited you're interested in 1:1 coaching! Please fill out the information below. After I review your responses, if I believe you are a fit for our program, I'll reach out to you and we can schedule a 20-minute discovery call.
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What is your name?
Please add contact info here (phone number and email address):
What is your age? *
What is your biological sex?
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How tall are you?
How much do you weigh right now?
If you know your body fat percentage, please input it here, along with the method you used to calibrate:
What is your top goal?
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What is your preferred eating style?
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How many meals do you like to eat each day?
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How active are you each day?
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What best describes your weekly workouts?
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What is a struggle or obstacle that prevents you from achieving your goals?
Have you ever had heart trouble or coronary disease?
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Do you have a family history of heart problems or coronary disease? If yes, please explain:
Do you have a history of high blood pressure (above 140/90)?
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Do you have diabetes? If yes, please provide name of your doctor
Has your doctor ever said you have high cholesterol?
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Please list any prescribed medications you are taking:
Please list any drug allergies:
Please list any over the counter medication or dietary supplements you are taking:
Do you have any unique situations that would prevent us from doing a virtual movement assessment? (Squat, plank, push-up) Any other health issues I should know about?
Do you have trouble sleeping? How many hours of sleep per night?
How much water do you drink per day?
Have you ever participated in a diet and/or nutrition program? Did you achieve your goal(s)? Was it permanent?
How would you rate your current fitness level on a scale of 1-10?
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What would you like to change about your health or the way you look?
What does your current weekly fitness routine look like?
Do you know how many calories you are currently eating per day?
Program pricing starts at $3,000 with a minimum 6-month commitment (and multiple pricing plans available). Are you ready to invest in your health?
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I understand that this program is for informational purposes only. I assume all risks from participation in this fitness assessment and resulting recommendations. Results are not guaranteed. I agree that I am voluntarily participating in the aforementioned activities and assume all risk of injury, illness, damage, or loss. [Please type your name as your signature] *
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