Application for 1:1 Coaching with Holly
Name *
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Email *
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What is the biggest change you want to make in your health in the next 3 months? *
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What's the biggest change you want to make in your life in the next year? *
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Check the things that are most important to you. *
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What is the most important dream you have had for yourself that you've put off? *
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What is keeping you from realizing this dream?
If someone were to write one-sentence story about you, what would they say? *
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What are your goals/expectations for coaching? Do you have any questions for me? *
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Please let me know about medical history you think I should know? Diabetes, eating disorders, thyroid disorders, depression, injuries, etc. *
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On a scale of 1 (poor) to 10 (excellent), how would you rate your satisfaction with your current physical activity level? *
How would you categorize your current activity level? *
Describe your physical activity in the past year (aerobic, muscular strength, &/or flexibility development; include structured classes as well as recreations *
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What did you most enjoy? *
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What do you want to try? *
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Describe current & previous limitations (knee pain, etc.) *
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Please list any/all fitness equipment you own and fitness memberships you have: *
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Do you have any specific athletic performance goals? *
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On a scale from 1 (poor) to 10 (excellent), how would you rate your satisfaction with your current eating habits? *
How would you describe your current eating habits? *
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Describe your typical weekday meals (breakfast, lunch, dinner, snacks, meals ordered out): *
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Describe your typical weekend meals: *
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Please list any food aversions/allergies/dislikes: *
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List any weight management programs done in the past 5 years: *
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On a scale of 1 (poor) to 10 (excellent), how would you rate your general stress level? *
On a scale of 1 (poor) to 10 (excellent) how would you rate your energy level? *
On a scale of 1 (poor) to 10 (excellent), how would you rate your sleep? *
Please list your height and current body weight: *
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On a scale of 1 (poor) to 10 (excellent) how would you rate your satisfaction with your body? *
Describe *
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What specific outcomes are you looking for from this coaching experience? Please describe in detail. *
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What efforts have you made to create this change in the past month? *
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On a scale of 1 (poor) to 10 (excellent), how would you rate your belief in your own abilities? *
Rate your readiness to create this change: *
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.) *
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Have you ever worked with a coach? If so, what worked well for you and what did not work well in the relationship(s)? *
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Describe your ideal coach (i.e. nurturing vs. no-nonsense, etc.) *
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What approaches discourage or de-motivate you? *
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How will you know if you are receiving value from this coaching relationship? *
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What else would you like me to know? *
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This form was created inside of Coach Holly Garnett.