Justin Miller: Personal Coaching Application
Oh hello there.
Please answer all questions in as much detail as possible and then hit that pretty blue "Submit" button. Once you have filled out the form I will review it and assess whether I can help you achieve your goals. I will then contact you within 2-3 business days to set up a consultation call.
Can’t wait to hear from you!
Justin
** These questions are for my purposes only and will never be shared.**
* Required
Email address
*
Your email
ABOUT YOU
First and Last Name
*
Your answer
Age
*
Your answer
Gender you identify most with
*
Male
Female
Other:
Telephone # (best number to reach you at)
*
Your answer
What is your occupation?
*
Your answer
COACHING OPTIONS
What type of coaching are you interested in?
*
Training and nutrition
Nutrition only
Required
Are you interested in online or in-person coaching?
Online
In-person (Southern California residents only)
Both
Clear selection
Have you ever had a personal coach before?
*
Yes
No
YOUR GOALS
What would you like to achieve in the next 12 weeks?
*
Your answer
What would you like to achieve in the next year?
*
Your answer
What's your biggest struggle when it comes to achieving your goals? (Or what's preventing you from already having achieved your goals?)
*
Your answer
Why now? What's motivated you to seek out coaching?
*
Your answer
TRAINING AND EXERCISE
Are you currently exercising?
Yes
No
Clear selection
What does your training currently consist of? (Crossfit, running, strength training, walking, yoga, etc...)
*
Your answer
Please list any current and past injuries or areas you have pain
*
Shoulder
Knee
Lower back
Elbow
Hip
Other:
Required
NUTRITION
Are you willing to work on nutrition "basics" and "fundamentals?"
Yes
No
Clear selection
Are you willing to track your calories and macro's if needed?
*
Yes
No
I don't know what that means
What do you struggle most with (select any and all that apply)
Emotional / stress eating
Lack of planning (time to prepare)
Cravings
Snacking when not hungry
Eating too quickly
Eating out frequently (few home cooked meals)
Large portions (portion control)
Don't know what I should eat
Unsupportive environment
Other:
COMMITMENT
How much are you willing to invest in yourself and your health on a monthly basis?
*
$99 - $199
$200 - $299
$299+
Are you 100% committed and serious about achieving your fitness goals? (coaching only works if you are)
Yes, Justin. I'm so committed I'd put a ring on it
No, I'm just kicking tires
Clear selection
Is there anyone else that may be involved in your decision to hire a coach or stick to a fitness program?
*
Your answer
What is your biggest concern or worry about hiring a personal coach?
*
Your answer
FOR SHITS AND GIGGLES
What are you currently reading or watching?
*
Your answer
Did you cry during the first scene of the movie "Up" or are you a liar
*
I did!
No (therefore I am a liar)
Never seen it (this will be your first homework assignement)
You can only live with one of these. What do you choose?
*
Chocolate
Cheese
Wine
Netflix
Other:
Congrats. You're all set.
That's it!
You made it - thank you!
If there is anything else that you feel I should know before I review your application to see if we're a fit, go ahead and send it over.
Hit me up at
justin@justinthomasmiller.com
Hope you have a great day, and I'll get back to you within 24-48 hours.
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