HLP Fitness & Nutrition Coaching Application

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Please fill in this form with as much detail as possible so I can get to know you a little better.

Fill out the application below to see if you are a good fit and I'll get back to you within 24 hours - unless I'm fighting crime, then it may take longer (shh don't tell anyone)

What is your email? *

What is your first and last name? *

How old are you? *

How tall are you? *

What is your weight? (in kg) *

What is your phone number? *

What is your favourite book of all time? *

What are the most important things in your life? (Maximum of 4 in bullet points) *

What is your occupation? (How many hours do you spend working each day?) *

How many hours sleep do you get a day *

Less than 4

5-6

7-8

9-10

10+

How well would you rate your sleep in general? *

I sleep great

I find it difficult to sleep and often wake in the night

How in control do you feel of your life?

I am in complete control

I have control over some aspects but not others

I have very little control - work/finances etc dictates my life

Clear selection

How much time do you spend a day either on your phone or on a computer? *

1 hour or less

2-3 hours

4-5 hours

6-7 hours

8 hour +

Do you spend time on your phone or electrical device in bed or in your bedroom at bedtime? *

Yes

Maybe

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