Application for Coaching

First Name *

Last Name *

Instagram Handle *

Phone *

Email *

Male or Female? *

Male

Female

What age bracket do you fall into? *

18-25

25-35

35-55

55+

Where are you located? *

What is your occupation? How many hours per week do you work? *

Which of the following best describes your current goals/challenges? (select all that apply) *

I want to lose fat (lose weight)

I want to build muscle (gain weight)

Improve Performance (strength, endurance, etc.)

I want to improve my overall health, increase energy, etc.

What is your exercise experience? (Scale of 1-10) *

Which best describes your nutrition for the last 30 days? *

Have you been diagnosed with an eating disorder? *

What is it you are looking to gain from having a coach? *

What is the biggest hurdle you’ve been trying to overcome with your fitness? *

What is your commitment level to your personal results? *

1. I’m extremely committed. I’m sick of my own bullshit, and I will do whatever it takes.

2. I’m committed enough to invest in my goals but I’m afraid of “missing out” on social events.

3. I know I need help to make a change but I’m not sure if I’m ready to fully commit.

Anything else you'd like to add before booking? *