JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Client Intake Form
Please take a few minutes to fill this out and let me know more about you! I offer one-on-one coaching for busy professionals who are ready to invest 3 months into their fitness goals.
Fill out this form
Schedule a personal phone call with me
Discuss your specific goals and formulate an action plan
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First and Last Name
*
Your answer
Cell Phone Number
*
Your answer
What do you struggle with the most related to your health and fitness?
*
Time
Motivation
Not Knowing What to do
Just don't want to
Other
What are your top 3 goals that you want to achieve with me?
*
Gain Strength
Drop BodyFat
Gain Confidence
Improve Performance
Other
How ready are you to commit to yourself?
*
Not ready
1
2
3
4
5
Ready to Win
My one-on-one coaching is for those who are serious and can invest their energy into themselves and their health. Can you make the financial and emotional investment into my coaching?
*
Yes
No
Have you worked with a health and wellness professional before?
*
Yes
No
If you are accepted into my program you will be offered the opportunity to sign up immediately! Do you have the financial means to invest into your health? There is a financial commitment associated with working with me.
*
Yes
No
Does anyone else (Spouse/parent) need to be included into this financial decision?
*
Yes
No
What is your favorite meal/food? I love a good steak but Chips and Salsa is hard to beat too!
*
Your answer
What is your favorite movie? I'm a big fan of any sports movie, A Few Good Men, and Most of Pixar!
*
Your answer
Do you understand that no magic pill, wrap, juice cleanse, or tea will get you to where you want to be, and that hard work is needed to get you to your goals?
*
Yes
No
By submitting this form, you will be entered into my email list. Understand you can unsubscribe at any time.
*
Agree
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms