Online Coaching Form

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If you've gotten this far I know you feel frustrated with where to start or how to get to the next stage.

Congratulations on deciding to take the first step in your transformation. I can't wait to help you unlock your full potential and change your body and mind. First things first, I need to learn a little bit more about you, your goals, and your lifestyle to best design a program that meets your exact needs. I offer HIGHLY committed individuals the opportunity to take advantage of two different coaching packages which are for all ages and fitness levels whether you're training at home or a gym. The coaching packages are:

GET FIT PLAN: (4 or 12 week packages)
Five Workouts per Week
Grocery Shopping List
Supplement Guidance
Nutrition Guidance
Strength and Conditioning Programs
HIIT Programs for At-Home or Gym
Bi-Weekly Accountability Check-ins
Unlimited E-mail Access
4 Weeks: $120. 12 Weeks: $300

NEXT LEVEL PLAN: (4 or 12 week packages. In Person Only available for DMV residents, Virtual Available Outside of DMV)
Five Workouts per Week
Grocery Shopping List
Supplement Guidance
Nutrition Guidance
Strength and Conditioning Programs
HIIT Programs for At-Home or Gym
Bi-Weekly Accountability Check-ins
Unlimited E-mail Access
1 hr In-Person One-on-One Session/ month
4 Weeks: $180. 12 Weeks: $480

Buckle up because this will not be your average training guide experience where you buy an online program and who knows if you ever complete a single workout. These workouts will be tailored for your specific needs. Week 1, you will receive a complimentary goal alignment session and complete a series of baseline strength and conditioning tests to efficiently benchmark your progress and hold you accountable to making progress. This is a very high-touch, performance-based training experience and I will be with you on-demand every step of the way to ensure you stay motivated and on track.

The first step in this process is filling out the below application to see if we are a good fit for each other. Please take your time and be as thoughtful and thorough as possible with your responses. The more detail you provide, the better I can "get to know you" and eventually deliver a program that best meets your needs.

After the form is submitted, I will review your answers and will reach out via email to set up your complimentary Goal Alignment Session and discuss the program in more detail.

THANK YOU again for your interest in my coaching services and I can't wait to help you look and feel like the champion you are!

-Jamaal Piper

Email Address *

Full Name *

Phone Number *

City, State *

Gender *

Male

Female

Age *

Height *

Weight *

Do you have any dietary restrictions? *

None

Vegan

Vegetarian

Gluten Free

Occupation *

Describe your daily activities: *

Sedentary: doing nothing all day like sleeping and watching TV.

Very light activity: doing nothing physical, like working a desk job without performing any type of physical activity during your day.

Light activity: having a non-physical job, but performing some sort of physical activity during the day, like walking, but no hard training.

Moderate activity: having a non-physical job, performing some sort of physical activity during the day, and including a daily workout session in your routine. This is where most of you are at

High activity: either training plus a physical job or non-physical job and twice-a-day training sessions.

Extreme activity: a very physical job and daily hard training.

Other:

Please list THREE goals. These can be a number on the scale, a look, a feeling, something health related - what are you working towards? *

What is your WHY? Your WHY is your deeper meaning, cause or belief that inspires you. It is your driving force behind your goal. *

What has been your biggest hurdle or obstacle you have faced during your fitness journey? *

Have you ever worked with a coach before? If so, how was your experience?

Do you have access to a gym? *

Yes

Have you ever played a sport? If yes, what sport? and at what level? *

Which of the following best describes your body type? *

Ectomorph: Lean and long, with difficulty building muscle.

Mesomorph: Muscular and well-built, with a high metabolism and responsive muscle cells.

Endomorph: Bigger, high body fat, often pear-shaped, with a high tendency to store body fat.

Have you ever had any injuries or chronic pain? (If YES, please explain.) *

Have you ever had any major surgeries? (If YES, please explain.) *

Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? (If YES, please explain.) *

Describe your current stress levels *

No stress at all

Extremely stressed

How many hours of sleep do you average each night? *

How committed are you to investing in your best self? *

I’m highly committed and have the financial means right now

I’m committed but do not have the financial means right now

Which program are you willing to commit to at this time?. *

GET FIT 4 Wk Package - $120

GET FIT 12 Wk Package - $300

NEXT LEVEL 4 Wk Package $180

NEXT LEVEL 12 Wk Package $480

I am unable to invest in my future self at this time but would be interested in future programs and offers

Is there anything else you'd like me to know about you? *

What is your instagram handle? *

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