Health Coaching Enrollment Form
Thanks for taking the time to enroll. Once you've submitted this enrollment form click the booking link that appears in the thank you message to schedule your complimentary 15 min coaching session with Louis Coraggio. Please note all information received will remain private and confidential.
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Email *
1. What is your name?
2. How did you hear about Louis Coraggio's TrampoLEAN program? *
3. Where do you currently live? *
4. What is your preferred pronoun? *
5. What do you most want from having a coach?
6. What is your age and D.O.B? (optional)
7. What is your height and weight? (optional)
8. Do you experience chronic aches/pains and/or do you have medical conditions? If so, please list and note what tends to make them worse and/or better. *
9. Please check your primary personal health / fitness goals. *
Required
10. Do you have access to any fitness equipment? If yes, please list. *
11. Please share specific details about your primary health / fitness goals: *
12. How long have these goals been important to you? *
13. Please list what you find exciting and meaningful about achieving your fitness goals (physical, mental, social, family, personal, professional). *
14. Have you tried accomplishing these goals before? If yes, what contributed to your success and what obstacles / challenges did you experience? *
15. On a scale of 1-10 how motivated are you in achieving these goals presently? (1 low / 10 high) *
low
high
16. What are the reasons you choose the score you did and not a lower score?
17. On a scale of 1-10 how confident do you feel in reaching these goals presently? (1 low / 10 high) *
low
high
18. What areas of health & fitness would you like to build your skillfulness?
19. How many days per week would you like to commit to physical activity and what is your preferred time length?
20. How much sleep do you normally get per night?
21. How many servings of caffeine do you normally have per day?
22. How many servings of sweets do you normally have in a day? *
23. How many servings of vegetables do you normally have per day? Please share any of your favorite veggies. *
24. How many servings of fruit do you normally have per day? Please share any of your favorite fruits. *
25. Do you tend to eat protein with each meal? Please share your preferred protein sources. *
26. Have you had success with any healthy eating plans in the past? *
27. Monday - Friday, how active would you rate your daily activity from a scale of 1-10? (1 low / 10 high) *
low
high
28. Monday - Friday, roughly how many hours a day do you sit? Are you up and down often or do you sit for a majority of time? *
29. Do you own a fitness tracking device? If so, please list the model. *
30. Do you take part in physical activities on the weekends or weekdays? If yes, please specify the type of activity and frequency. *
31. Have you tried health coaching in the past? If yes, what did you like and would did you want more of? *
32. Please check any aerobic activities that you prefer or would like to explore? *
Required
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