Virtual Gym Interest Form

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Please note submitting this form does not obligate you to anything...just helps me be a better coach for you!😉

Email *

Name (First and Last) *

Mobile #

Do you currently have a BODi coach?

Yes

You (Lora Smith) are my coach

Not sure

Clear selection

In which of these areas could you use help? (Check all that apply.) *

Nutrition

Daily Motivation

Where to start/what to do

Daily Accountability and support

Weight loss/fat loss

Other:

Required

How would you describe your current fitness level?

Beginning -- I'm not working out at all or just recently started working out.

Intermediate -- I consistently work out 3-5 days/week.

Advanced - I consistently work out 4-6 days/week.

Clear selection

How many days per week would you be willing to exercise?

5-6

Would prefer to focus on nutrition ONLY to start

Clear selection

How much time each day could you set aside for your fitness? (Skip if you chose last answer above.)

20 Minutes

30 Minutes

45 Minutes

1+ Hour

Clear selection

At the end of 1 month, what do you want to say you accomplished in regards to your health and fitness? *

What do you feel you would want/need most from me as your health coach? *

Submit

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