Coaching Application
First Name
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Last Name
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Email
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What is your birthday? MM/DD/YYYY
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What is your cell phone number?
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What is your height and weight?
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Where do you live? (closest major city) / what time zone are you in?
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How did you hear about me?
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How do you prefer me to contact you
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Mobile
Email
Text
What services are you interested in? Check all that apply
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personal training/coaching in-person
online training (no live sessions)
remote training (sessions via Zoom)
mobile training (I come to you within 10 miles of 76118)
Not sure, let's chat
In general, what are your goals? Check all that apply
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lose weight/fat
gain weight
maintain weight
gain muscle
improve health
improve physical fitness
look better
feel better/more energy
healthy aging
eat better/get control of eating habits
get stronger
improve athletic performance
other (leave specifics at the end question)
What is your main goal (be as specific as possible)
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Why is your goal important to you?
If you were to consider maybe making more changes to your habits, your health, your eating, and / or your body, what might those be?
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Until now, what has blocked you or held you back from changing these things
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Right now, how would you rank your overall eating / nutrition habits (1-10 1 is horrible, 10 is awesome)
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Approximately how many hours per week are you active in exercise or sports? Briefy describe your routine
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Approximately how many hours a week do you do other types of physical activity? (e.g., housework, walking to work or school, home repairs, moving around at work, gardening)
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Have you have been diagnosed (currently or in the past) with any significant medical condition(s) and / or injuries?
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Right now, do you have any specific health concerns, such as illnesses, pain, and / or injuries?
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Right now, are you taking any medications, either over-the-counter or prescription
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On a scale of 1-10, how would you rank your health right now? (1 is worst, 10 is best)
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What do you expect from me as your coach?
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Is there anything else you think I should know about you before we start working together? List any additional goals not mentioned yet
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Disclaimer: The information provided is intended for educational and informational purposes only and should not be considered medical advice. Please consult your healthcare provider before making any significant changes to your fitness or nutrition routines. If you choose to apply this information without medical clearance, you do so at your own discretion and assume full responsibility. Health coaching is not a substitute for medical care, diagnosis, or treatment and should be used to complement, not replace, guidance from your medical team.
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I agree
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I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.
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