The Daily Push Coaching | application form
Hey!

Thanks for your interest in coaching!

I'd be hyped to work with you, but just to make sure I'm actually able to help you I need you to fill this quick form. It's a short one and should just take a couple of minutes.

If you've got any questions about the coaching process or anything in this form you can leave them at the bottom of the form or hit me up directly at thedailypushonline@gmail.com

Looking forward to hearing from you!
Matt
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Email *
What's your name? *
How old are you? *
Which country do you live in? *
What motivated you to want to start working with me? *
What are some of the main skate related issues you're hoping to resolve or areas you're hoping to improve by working with me? *
What are some of the main health, fitness or wellbeing related issues you're hoping to resolve or areas you're hoping to improve by working with me? *
Has your doctor ever said that you have any health condition? Have they ever told you you have a heart condition OR high blood pressure? *
If you answered yes to the last Q, list what you have below
Has your doctor ever said that you should only make nutritional changes or do physical activity recommended by a doctor? *
Do you feel pain in your chest at rest, during your daily activities, OR when you skate or do physical activity? *
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? *
Do you currently have, or are still recovering from, a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by skating or doing more exercise? *
If you answered yes to the last Q, list what below
Do you have any regular pain when you skate or do exercise? *
If you answered yes to the last Q, list what below
Are you currently taking prescribed medications for a chronic medical condition or any medications that can be affected by nutritional changes, skating or other exercise? *
Do you have any health conditions that can be affected by nutritional changes, skating or other exercise? *
If you answered yes to the last question - give your reasons below
Do you know of any other reasons why you shouldn't participate in a training or nutrition coaching program? *
If you answered yes to the last question - give your reasons below
If your answers to any of these questions change during our time working together you'll let Matt know *
Do you have any questions or comments?
I confirm that this form was filled out by me and not my dog
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