1-On-1 Coaching Application
Thanks for your interest in my 1-On-1 Coaching Program. My name is Jack Perez and I have been a personal and group fitness trainer for 4+ years. This application will help me better understand your health and fitness goal(s) and what you personally need to achieve them.

My coaching focuses on building sustainable habits that will lead to life-changing results and long term adherence. Every person is unique so I will be working with you closely to make sure the program is specifically tailored to you, your life and your goals.

This form will help me determine if you are currently a good fit to start my program. Please fill out the form to your best ability and I look forward to speaking with you.
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What is your first and last name? *
How old are you? *
What is your gender? *
What is your primary fitness goal? *
Tell me about your fitness goal. What are you looking to get out of this program? And why? Please be specific. *
Why do you think you haven't been able to accomplish your goal on your own? *
What is your current occupation? Please be specific. Helps me know what kind of plan would work best for you. *
What is your email? *
What is your phone number? *
What is your Instagram user name? (If you don't have one put N/A) *
On a scale of 1-5 how important is it to you to achieve you goal(s)? *
not important at all
very important
Have you ever worked with an online coach or personal trainer in the past? If so, how was your experience? *
On a scale of 1-5 how ready are you to make a significant financial investment in your health and fitness? *
not ready at all
very ready to significantly invest for a significant goal
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