Application for 1:1 Coaching with Holly
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Name
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Your answer
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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Your answer
What's the biggest change you want to make in your life in the next year?
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Your answer
Check the things that are most important to you.
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career
fitness
family
health
leisure
life purpose
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What is the most important dream you have had for yourself that you've put off?
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Your answer
What is keeping you from realizing this dream?
time
support
resources
other
Clear selection
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?
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How would you categorize your current activity level?
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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
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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?
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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?
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On a scale of 1 (poor) to 10 (excellent) how would you rate your energy level?
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On a scale of 1 (poor) to 10 (excellent), how would you rate your sleep?
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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?
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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?
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Rate your readiness to create this change:
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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.)
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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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Your answer
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