Coaching Candidate Intake Form

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This form will allow me to learn more about your goals and lifestyle, and also to make sure we are a good fit for one another.

Your plan will be focused on your goals, lifestyle, but we will make sure you have the support to get stronger and healthier.

Please email authenticallywell@gmail.com with all questions and allow 24-48 hours. No weekend availability at this time.

Fill this form out and it will help me get to know you better and your limitations.

I will have your plan in 4-5 days after you submit this form via email.

-Has

Email *

First and last name *

Phone Number *

What's your current weight? *

What's your goal weight?

What's your current height? *

Do you have a pair of Jeans or a Dress size smaller than your current size? *

Yes

No, but I can find some.

Please list all injuries or surgeries ( in full detail) within the last 5 years. *

Please list all the foods you're allergic to or JUST HATE and refuse to eat. *

List all current medications. (if you're not on any, replay with "n/a") *

Please list ALL workout equipment you have access to at the moment. *

Are you interested in quick weight-loss OR long term sustainable results? and Why (pick one) *

I understand the program will be available within 5 days. *

I understand.

Required

I understand I have to upload my photos weekly on my app to track progress on Fridays. *

I understand.

I understand this process is a 50/50 relationship and will require work to see results. *

I understand.

I understand Coach Has will not complete every single workout with me, I must complete workouts on my own but can ask for help anytime. *

I understand.

Required

I understand Coach Has will teach me how to eat for my goals (via Zoom) and I will receive a meal plan sample, not a customized meal plan. *

I understand.

I understand all transactions are final. *

I understand.

I understand that this is my meal guide in the link below and I must download it to access it. *

I understand

https://docs.google.com/spreadsheets/d/1pTMTIEt4gkIpYezsNyhUJuSuLsXgr5KqIKUOoyH7hc4/edit?usp=sharing

Required

I have to access the FB group by clicking the link to see where all the trainings are. *

I understand

https://docs.google.com/spreadsheets/d/1pTMTIEt4gkIpYezsNyhUJuSuLsXgr5KqIKUOoyH7hc4/edit?usp=sharing

Has is off Sundays. *

I understand

I can expect respect 24 hours for Has to get back to me Mon-Sat. *

I understand

My nutrition check-ins are EVERY Thursday *

I will set a reminder on my phone.

Programs are sent out Tuesdays *

Yes, and I will put a reminder on my phone.

A copy of your responses will be emailed to the address you provided.

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