First Name
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Last Name
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Instagram Handle
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Phone
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Email
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Which of the following best describes your current goals/challenges? (select all that apply)
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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.
Which best describes your nutrition for the last 30 days?
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I track my meals/macros
I'm following a meal plan
I have tracked my food or diet in the past, but have not been lately.
I have no idea where to start with my diet/nutrition
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Have you been diagnosed with an eating disorder?
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Yes
No
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What describes your fitness for the past 30 days?
I'm currently working with a performance coach towards a specific goal
I'm following a one-off, progressive plan (general or customized)
I find random workouts from social media to follow on gym days
My training is inconsistent and sporadic
I am not currently working out and am confused with where to start
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Do you struggle with any of the following? (Select all that apply)
Body Dissatisfaction
Stress, anxiety and trouble losing weight
Unhealthy relationship with food and dieting
Binge eating
Inconsistent with nutrition
Inconsistent with working out
Bad relationship with fitness
Until now, what has blocked you or held you back from being where you want to be?
What is it you are looking to gain from having a coach?
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What is your commitment level to your personal results?
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1. I'm extremely committed. I'm tired of self-loathing and I will do whatever it takes!
2. I'm committed enough to invest in my goals but I'm afraid of not being consistent when life gets stressful.
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?
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