1:1 Online Coaching Application
Thank you for your interest in working with me! Please answer the questions below so I can assess your needs and goals.  Upon completion of this form, I will reach out to you to schedule a consultation call, where we will determine if we are a good fit and discuss in more detail what options are best for you!

I am looking forward to getting to know you and to get started reaching your goals!

PS - this is for online coaching ONLY! If you are interested in in-person training sessions, please visit www.activelifelongbeach.com to book a discovery call.
Sign in to Google to save your progress. Learn more
Email *
Full Name *
Phone Number *
Instagram Handle
How did you hear about me? If someone referred you, please tell me - I would LOVE to thank them! *
Why have you chosen to work with me? *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Gender *
Height (feet, inches) *
Current Weight (lbs.) *
Tell me about yourself. What do you do for a living? What is your daily life like? *
What is the activity level at your job? *
Do you participate in activities outside of work or the gym? If so, please list them. *
Do you have any diagnosed health problems? If so, please list your condition(s). *
Do you have any current or prior injuries I should know about? If so, please list them *
Please list any medications you are currently taking for any current health condition(s) or injuries. *
Are you a current tobacco smoker? *
How is your prior experience with exercise and nutrition? Have you ever worked with a coach before? If so, what were your likes & dislikes? *
What are your fitness goals? Check all that apply. *
Required
What does your current diet and exercise routine look like? *
How often do you currently workout? *
Rate your ability to perform cardio exercises *
Very Low
Excellent
Rate your experience with weight lifting *
How frequently do you have time to exercise? *
What do you think you need most to achieve your goals? *
Required
What are some things that have worked or didn't work for you in the past? What struggles have slowed down your progress on your fitness journey? *
Are you willing to spend a few hundred dollars per month (minimum of 3 months for online coaching) to make this physical, mental & financial investment in your health & fitness? (PS. We will discuss all of the pricing options on our call!) *
Does anyone else need to be apart of this decision?  If so, please speak with them before to know where they stand on this decision. *
What is your availability like for a consultation? *
Any other comments or questions?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms