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