Online Coaching Application Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Online Coaching is really the most effective and affordable way I can offer my services as a health and fitness coach. With Online Coaching, I'm like your very own virtual personal fitness consultant...here for your every health and fitness need!

Basically: everything I do with my in-person clients, except done through the web via email, text, and an easy to use app on your phone!

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 on the softball field stretching singles into doubles, or jamming out at a concert. Then it may take longer.

Email *

Who are you...

Let's get the easy stuff out of the way first.

First Name *

Last Name *

Age *

Gender *

Female

Male

Other:

Phone Number *

Tell my why...

These answers will help me to learn just WHY you are interested in Longevity Strength + Fitness Online Coaching

Which option BEST describes your current situation? *

I want to lose weight. Preferably yesterday.

I want to get strong and ripped.

Sure, losing weight and getting ripped is cool and all, and if that's a byproduct of my program, sweet, but what I really want is just to be stronger, more mobile, and overall feel and perform better.

Which option BEST describes what you are currently doing to address that situation? *

I'm CURRENTLY sitting on my couch watching Netflix. It's on pause so I can fill out this application.

I used to do things to address it, but I've fallen off that wagon and landed on the couch. Time to get back on it.

I'm trying to exercise more and eat better, but it's not really getting me anywhere. Thus me filling out this application.

I'm doing good, maybe great, at addressing this, but I'm filling out this application because I want/need a coach to get me to the finish line.

What does Longevity mean to you and your life? *

Really think about this. What would a change mean for your life? For those around you? How would your life be different?

What do you think is your biggest obstacle to achieving that life? *

Lack of accountability? Lack of discipline? Lack of knowledge on how to do it? Lack of time? Etc.

How do you think my coaching will help you achieve your Longevity? *

Have you ever worked with a fitness coach/trainer before? *

Yes

Have you ever worked with an online coach before? *

Yes

If yes to either of those two previous questions, what did you love about that experience? What were some of your frustrations?

Getting to know you...

Three of my favorite pastimes are sports, music, and movies/TV. Quick detour to get your thoughts on these subjects.

Sports: Would you rather... *

For me? Walk-off home run, all the way.

Score the winning goal to win the FIFA World Cup?

Hit a walk-off home run to win the World Series?

Hit a buzzer beater to win the NBA Finals?

Throw a game winning touchdown pass in the Super Bowl?

Other:

Music: Who do you choose? *

I'll go Biggie, the Stones, and The Killers.

Notorious B.I.G.

Tupac

Biggie or Tupac?

The Beatles

The Rolling Stones

The Beatles or The Rolling Stones?

The Killers

The Strokes

The Killers or The Strokes?

TV/Movies: The movie/show you quote the most? *

Tough call, but I'm going Seinfeld. "The sea was angry that day, my friend."

Crunch Time!

Enough of the fluff questions about sports and entertainment. Are you ready to roll?!?!

On a scale of 1 to 5, 1 being "I'm good with sitting the bench and watching the others play" and 5 being "Put me in coach, I'm ready to play, today", how committed are you to making changes to improve how you look, feel, and move for your life today and for your Longevity? *

Are you ready and willing to invest just $100-$250 per month for coaching to change your life? *

YES! YES! YES! YES! YES!

Let's chat! I'm open and need more information.

Nah, I'm good with complaining but not doing anything about it for the rest of my life. Besides, medical bills and prescriptions are so much more fun to pay.

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms