Lifestyle Coaching Application
Thank you for your interest in working with me 1-on-1! This application is a pre-screening tool to rule out any glaring issues that would prevent someone from working a diet and exercise program such as serious injuries or illness. Please be honest in this application and if I think we'd be a good fit, I will reach out to get you on the right path to reaching your goals!
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name
Age: *
Three & Six Month Goals: *
Height: *
Weight: *
Please explain WHY these goals are important for you? What would achieving these goals mean to you? *
What have you done in the past that did or didn't work to reach your goals? Please be specific. *
What do you feel you struggle with most in reaching your goals? *
About how many calories do you eat daily? (macros if known). If unknown, please include a typical day of eating, including snacks and treats. *
Any major past injuries or current nagging issues? *
History of eating disorder? If yes, explain. *
Current Medications: *
Anything else you feel I should know: *
On a scale of 1-10, how coachable are you? *
Stuck in my ways and not open to suggestions
Open-minded and willing to take direction and feedback
On a scale of 1-10, what level of support will you require? (All clients will receive support - just gauging your independence here!) *
No support. Give me the plan and I'll execute
All the support. Multiple check-ins and weekly calls.
Have you worked with a coach before? If so, why are you looking to try a new coach? *
What lead you to reach out for coaching? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of teamloud.com. Report Abuse
Google Forms