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Application for Virtual Rehab & Training
1. Fill out this application to determine if you are a good candidate to work with me 1-on-1 to help you achieve your physical goals and to help you understand how to reduce your pain, improve your mobility, and improve your strength.
2. All applications will be reviewed and responded to within 48 hours. If for some reason you do not receive a response, please e-mail me at therunnerdoc@gmail.com
3. Please fill out the application thoroughly so I determine the best way I can help you!
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What is your First and Last Name?*
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Your answer
What is your e-mail address?
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Your answer
What is your cell phone number?
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Your answer
What are the current problems that you're dealing with?*
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Your answer
What have you tried (if anything) so far to solve your current problems or issues?
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Your answer
What have you tried (if anything) so far to solve your current problems or issues?
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Your answer
What is one activity that you currently are having difficulty doing that you would love to get back to?
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Your answer
Why do you want to work with me rather than someone else?
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Your answer
What do you need from me to achieve your goals?
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Your answer
In order to reach your fitness, rehab, and performance goals, it will most likely take 3+ months of being committed to a highly specialized and focused program. Is that something that you would be able to handle?
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Yes
No
My 1-on-1 coaching costs $500 per month. (discounts for multi-month purchases)
Are you able to make the above investment for the option you are pursuing?
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Yes
No
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