Nutrition Coaching Application

I am so glad you are ready to level up your nutrition and fitness game.  Please fill out the below and once it is submitted, I will be in touch with you within 24hrs with your next steps to start planning for your transformation.

I truly believe that if you change your mind, body and lifestyle, you change your quality of life and I am excited to help you learn how to reach your goals…all you have to do is commit.

If you have any information you would like to add to this, please send an email to me at cheryl@positiveimagefitness.ca

Thank you for choosing me to be your coach and let’s get you living your best life.

Talk soon

Cheryl


DISCLAIMER: please recognize that it is your responsibly to work directly with your health care provider before, during and after seeking any nutritional and or fitness advice. If you choose to use this information without approval, you agree to fully accept responsibility for your decision.


Email *
First and Last Name *
Phone Number *
Email *
Your birth date *
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Your age
Your Height
Your current weight
What do you want?  In general, what are your goals?  Check all the apply *
Required
Out of all the changes you would like to make, which ones feel the most important/urgent? *
Have you tried anything in the past or recently to change your habits, your eating and/or your body?  If so, what? *
Which of those things worked well for you and which of those things didn't work well and why? *
What is your biggest hurdle in reaching your goals and why do you want to make a change now? *
Right now, how would you rank your overall eating/nutrition habits?
1 being horrible
5 being awesome!
 *
What is your current nutrition routine like? (types of food, #of meals/day, are you currently tracking macros? Do you know your current calories and macros?)
Are you regularly active in sports or exercise?  If so, approx. how many hours per week *
What is your current workout routine (cardio, strength training, how many days/week, how long do you workout for?) *
Who does most of the grocery shopping in your household? *
Who does most of the cooking in your household? *
Who decides on most of the menus/meal types in your household? *
Right now, how much do the people and things around you support health, fitness and /or behaviour change?
1 being not at all
5 being completely on board
 *
Do you have any current or past health concerns, medical conditions, pain or injuries?  Are you taking any medications either over the counter or prescription? *
On a scale of 1-5 how would you rank your health right now?
1 being worst ever
5 being awesome
 *
On a scale of 1-5 how do you feel about your schedule, time use and overall busy-ness?
1 being my life is packed and insane
5 being my life is calm and relaxed
 *
On average, how many hours per night do you sleep? *
How do you normally cope with stress? *
How READY, WILLING and ABLE are you to change your behaviours and habits?
1 being not at all
5 being completely
 *
Coaching requires an investment financially, physically and emotionally and I want us to be a YES to working together.  Are you ready to invest in yourself? *
How did you hear about Positive Image Fitness and the Lift Yourself LEAN program *
Once I have received your application I will reach out to you via email to set up a phone call to go over your application and how the coaching program works in more detail.
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