Application for 1:1 Coaching with Holly
* Required
Name
*
Your answer
Email
*
Your answer
What is the biggest change you want to make in your health in the next 3 months?
*
Your answer
What's the biggest change you want to make in your life in the next year?
*
Your answer
Check the things that are most important to you.
*
career
fitness
family
health
leisure
life purpose
Required
What is the most important dream you have had for yourself that you've put off?
*
Your answer
What is keeping you from realizing this dream?
time
support
resources
other
If someone were to write one-sentence story about you, what would they say?
*
Your answer
What are your goals/expectations for coaching? Do you have any questions for me?
*
Your answer
Please let me know about medical history you think I should know? Diabetes, eating disorders, thyroid disorders, depression, injuries, etc.
*
Your answer
On a scale of 1 (poor) to 10 (excellent), how would you rate your satisfaction with your current physical activity level?
*
1
2
3
4
5
6
7
8
9
10
How would you categorize your current activity level?
*
sedentary
lightly active
moderately active
very active
Describe your physical activity in the past year (aerobic, muscular strength, &/or flexibility development; include structured classes as well as recreations
*
Your answer
What did you most enjoy?
*
Your answer
What do you want to try?
*
Your answer
Describe current & previous limitations (knee pain, etc.)
*
Your answer
Please list any/all fitness equipment you own and fitness memberships you have:
*
Your answer
Do you have any specific athletic performance goals?
*
Your answer
On a scale from 1 (poor) to 10 (excellent), how would you rate your satisfaction with your current eating habits?
*
1
2
3
4
5
6
7
8
9
10
How would you describe your current eating habits?
*
Your answer
Describe your typical weekday meals (breakfast, lunch, dinner, snacks, meals ordered out):
*
Your answer
Describe your typical weekend meals:
*
Your answer
Please list any food aversions/allergies/dislikes:
*
Your answer
List any weight management programs done in the past 5 years:
*
Your answer
On a scale of 1 (poor) to 10 (excellent), how would you rate your general stress level?
*
1
2
3
4
5
6
7
8
9
10
On a scale of 1 (poor) to 10 (excellent) how would you rate your energy level?
*
1
2
3
4
5
6
7
8
9
10
On a scale of 1 (poor) to 10 (excellent), how would you rate your sleep?
*
1
2
3
4
5
6
7
8
9
10
Please list your height and current body weight:
*
Your answer
On a scale of 1 (poor) to 10 (excellent) how would you rate your satisfaction with your body?
*
1
2
3
4
5
6
7
8
9
10
Describe
*
Your answer
What specific outcomes are you looking for from this coaching experience? Please describe in detail.
*
Your answer
What efforts have you made to create this change in the past month?
*
Your answer
On a scale of 1 (poor) to 10 (excellent), how would you rate your belief in your own abilities?
*
1
2
3
4
5
6
7
8
9
10
Rate your readiness to create this change:
*
I can't do it
I may do it
I will do it
I'm doing it
What other improvements would you like to make in your life? (Consider the areas of: Family/friends, finances, career, service/character, personal growth/learning, spiritual path, home organization, creativity, play/leisure, etc.)
*
Your answer
Have you ever worked with a coach? If so, what worked well for you and what did not work well in the relationship(s)?
*
Your answer
Describe your ideal coach (i.e. nurturing vs. no-nonsense, etc.)
*
Your answer
What approaches discourage or de-motivate you?
*
Your answer
How will you know if you are receiving value from this coaching relationship?
*
Your answer
What else would you like me to know?
*
Your answer
Submit
Never submit passwords through Google Forms.
Forms
This form was created inside of Coach Holly Garnett.
Report Abuse
Terms of Service
Privacy Policy