1-On-1 Coaching Application Form
Kevin Shields Fitness is proud to offer the most comprehensive Online Coaching Program for men and women living with pre-diabetes, diabetes, or are ready to lose their last 30 pounds of body fat. The Elite Transformation coaching program combines the unique blend of fitness, habit-based nutrition, and lifestyle support custom tailored to your goals.

If you're ready to take control of your health, apply today and I will contact you within 24 hours of your submission.

Talk soon,
Kevin Shields, MS

Name: *
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Email: *
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Phone Number:
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Age: *
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Height: *
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Weight: *
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Would you rather have sushi or tacos for the rest of your life? You get unlimited stuffing with whatever you want. *
Have you every worked with an online fitness or health coach before? If so, can you tell me about it? *
Your answer
How would you rate your current level of fitness? *
Couch Potato
Superhero
Do you have any health issues, medical problems, or anything I need to know about? *
Your answer
What do you hope to achieve in 3 to 6 months of coaching? *
Your answer
What type of exercise have you had success with in the past? *
Your answer
Do you have any specific nutritional restrictions? *
Why did you choose specifically to apply to my coaching program? *
Your answer
On a scale from 0 to 5, how important are achieving your health goals at this point in your life? *
I just want to sit on the couch and eat pizza
I will eat the same meal everyday for the next year if that's what it takes
Which coaching package interests you the most? *
How much are you willing to invest in yourself/health and fitness? *
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