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Justin Miller: Personal Coaching Application
Thank you for taking the next step in achieving your goals through individualized nutrition and lifestyle coaching with me.
Once your application is submitted I will review it and send a follow up email and video outlining the program for you.
with gratitude,
Justin
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Email
*
Your email
😊 ABOUT YOU
First and Last Name
*
Your answer
Telephone # (best number to reach you at)
*
Your answer
Age
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Your answer
Gender you identify most with
*
Male
Female
Other:
What is your occupation?
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Your answer
How did you hear about me (how did you find me?)
*
Someone referred me to you
Google search
Yelp
Instagram
Facebook
I'm been a newsletter subscriber for a while
Other:
🤝 COACHING OPTIONS
What type of coaching are you interested in?
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Training and nutrition
Nutrition only
Required
Are you interested in online or in-person coaching?
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Online coaching
In-person (Southern California residents)
Have you used/tried any of the services or methods before
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In-person personal trainer
Online personal trainer or nutrition coach
Weigh watchers (WW)
Noom
Tracking calories on your own
Precision Nutrition
Jenny Craig
Diets (Keto, Paleo, Vegan, etc...)
Intermittent fasting
Detox's
Other:
Required
🎯 YOUR GOALS
What is your primary goal?
*
Choose
Lose weight/body-fat
Increase muscle/strength
Body recomposition
Improve athletic performance
Improve relationship with food
Increase energy/vitality
Increase education on nutrition/exercise
If, 6-months from now, you were to feel exactly how you want to feel in your own body, what would that look/feel like? How would your life be different?
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Your answer
What's your biggest struggle when it comes to achieving your goals? (Or what's preventing you from already having achieved your goals?)
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Your answer
🏋️♀️ TRAINING AND EXERCISE
Are you currently exercising?
Yes
No
Clear selection
What does your training currently consist of? (Crossfit, running, strength training, Peloton, walking, yoga, etc...)
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Your answer
🥦 NUTRITION
What does your current diet / nutrition look like?
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In a calorie deficit
In a calorie surplus
Tracking my food / Macros
Doing a specific diet / etc
Not tracking my food at all
It's a hot mess and I need help ASAP
Other:
🤣 FOR SHITS AND GIGGLES
What are you currently reading or watching?
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Your answer
What are 1 to 2 personal interests or hobbies you enjoy?
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Your answer
Favorite travel destination or a place you've always wanted to go?
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Your answer
Congrats. You're all set.
You'll hear back from me in the next 24-48 hours via email.
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